C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program

Ruíz-Tóvar, Jaime; Muñoz, José Luis; González, Juan; García, Alejandro; Ferrigni, Carlos; Jiménez, M.I. Segado; Durán, Manuel

doi:10.1007/s00464-017-5602-1

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Furthermore, early decrease in Alb is a significant predictor for SPCs in colorectal cancer patients undergoing curative laparoscopic surgery [42]. Previous studies have also indicated Fib as an early marker of postoperative complications after laparoscopic sleeve gastrectomy in morbidly obese patients [43] or total joint arthroplasty [44]. This present study was the first to indicate preoperative AFR as an independent risk factor for SPCs in GC patients after radical laparoscopic gastrectomy.…”

Section: Discussionsupporting

confidence: 51%

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy

et al. 2019

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Background A high prevalence of postoperative complications is closely associated with a worse short- and long-term outcome. This current study aimed to investigate potential risk factors including albumin-to-fibrinogen ratio (AFR) for severe postoperative complications (SPCs) in surgical gastric cancer (GC) patients. Methods Elderly patients (≥65 years) with primary GC who underwent elective radical laparoscopic gastrectomy under general anesthesia were included. According to the Clavien–Dindo classification system, the severity of complications was assessed from Grade I to V and SPCs were defined as C-D Grade ≥ IIIa. The clinicopathological features, operative-associated characteristics, postoperative recovery and laboratory tests were compared between patients with or without SPCs. Receiver operating characteristic (ROC) curve analysis using Youden’s Index was established for determining the predictive value and cut-off threshold of AFR for SPCs. Binary univariate and multivariate logistic regression models were used to assess factors influencing SPCs. Results A total of 365 elderly GC patients were finally included in the analysis, of which 52 (52/365, 14.2%) patients had developed SPCs within postoperative 30 days. Preoperative AFR level predicted SPCs in surgical GC patients with an AUC of 0.841, a sensitivity of 76.36% and a specificity of 80.77%, respectively (P < 0.001). The multivariate analysis revealed that a lower AFR level (OR: 1.94, 95% CI: 1.09–3.36, P = 0.017) and an older age (OR: 1.81, 95% CI: 1.06–3.04, P = 0.023) were two independent predictive factors for SPCs in surgical GC patients. Conclusions Preoperative AFR level is a useful predictor for SPCs in elderly GC subjects after radical laparoscopic gastrectomy.

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Section: Discussionsupporting

confidence: 51%

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy

et al. 2019

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“…In our study population, the changes in postoperative WBC counts showed a low predictive ability of postoperative complications. This result is in accordance with those of other studies [16,32,36]. In particular, Swets et al [36] found that significant changes in the WBC count occurred 7 days after surgery when most postoperative complications have already had a negative clinical evolution.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, the circulating levels of fibrinogen may increase several-fold after the operative trauma, and these levels are greater the more intense the inflammatory response [15]. To date, the ability of fibrinogen to predict postoperative surgical complication has been shown only retrospectively and in small and very selected populations [16].…”

Section: Introductionmentioning

confidence: 99%

The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study

et al. 2019

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Background: Complications after laparoscopic gynecological surgery may increase patients' morbidity and mortality; therefore, their timely diagnosis and early treatment would help clinicians to avoid life-threatening situations. We aimed to evaluate the predictive role of fibrinogen for diagnosing complications after laparoscopic gynecologic surgery for benign and malignant conditions. Patients and methods: All patients who underwent elective laparoscopic gynecologic surgery between June 2013 and December 2017 at the Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, were prospectively included. Post-operative complications were assessed and graded according to the Clavien-Dindo classification. Fibrinogen and white blood cell level were determined preoperatively, on the first post-operative day and at the appearance of symptoms indicative of an irregular post-operative course or at the time of rehospitalization for persistent symptoms. The postoperative changes (calculated from the first postoperative day) were correlated with the occurrence and severity of complications and their predictive role was assessed. Results: We enrolled 1016 patients: 36% underwent surgery for benign pathologies (mainly voluminous fibromatous uteri and severe deep endometriosis) and 64% for gynecologic malignancies. The overall complication rate was of 3.45%, the rate of major postoperative complications was 2.85%. A postoperative fibrinogen increase ≥ 20% had a high diagnostic accuracy to identify postoperative complications early (AUC 0.931, sensitivity 89%, and specificity 99%). The magnitude of postoperative fibrinogen change was associated with complication severity. Conclusions: Our findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results.

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“…Munoz et al [30] and Kr€ oll et al [14] found a CRP cut-off value of 70 mg/L on POD1 to be a good indicator of septic complications after SG and for excluding AL in patients undergoing SG or RYGB [14,30]. Another study focused specifically on staple line leaks after SG and a CRP cut-off value of 90 mg/L achieved 85% sensitivity and 90% specificity [31]. Warschkow et al [26] found that CRP levels .22.9 mg/dL on POD2 provided the best diagnostic values for general complications after RYGB and sensitivity for intestinal leaks reached 100%.…”

Section: Discussionmentioning

confidence: 99%

The role of C-reactive protein after surgery for obesity and metabolic disorders

Chiappetta

Jamadar

Stier

et al. 2020

Surgery for Obesity and Related Diseases

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C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program

Cited by 20 publications

References 21 publications

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy

The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study

The role of C-reactive protein after surgery for obesity and metabolic disorders

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