Evaluation of inflammatory markers as predictors of hospital stay and unplanned readmission after colorectal surgery

Abstract

Hospital length of stay (LOS) and readmissions continue to be expensive and unexpected events following colorectal surgery (CRS) whether patients follow enhanced recovery pathways or traditional care. Predictors of these adverse events could facilitate identification and optimization of CRS patients. the aim of the study was to examine the impact of white blood cell count (WBC) and C-reactive protein (CRP) levels as predictors of delayed recovery or hospital readmission following CRS. material and methods. Patients undergoing laparoscopic or open abdominal colorectal surgery by a single surgeon were managed using standardized enhanced recovery pathways. Those with postoperative day 2 CRP and white blood cell values were evaluated. Outcomes included 30-day hospital readmission rates and postoperative length of hospital stay. results. CRP values were available for 193 patients (86 Male, mean age 58.6 years). Ninety-nine patients had surgery for colon cancer, 23 for Crohn's disease, 19 for ulcerative colitis, 31 for diverticulitis and 18 for other reasons. Twenty patients (10.4%) were readmitted to the hospital within 30 days of surgery. POD2 CRP accurately predicted short length of hospital stay (p< 0.01). Average CRP was 6.3 in the LOS of < 3 days or less, and 11.7 in patients with LOS >4 days. The mean CRP of the readmission and non-readmission groups was 11.8 and 9.9, respectively (p=0.29). The average POD 2 WBC of the readmission and non-readmission groups was 10.6 and 9 respectively (p=0.01). conclusion. A low POD2 CRP level was correlated with a shorter LOS, but it did not predict readmission. Conversely, POD2 WBC, and the difference in WBC from baseline were associated with readmission. These markers may be useful indicators to predict suitability of early discharge in an ERP. Further evaluation in prospective trials is warranted.

Systematic use of the serum C‐reactive protein concentration and computed tomography for the detection of intestinal anastomotic leaks

“…Early diagnosis is therefore essential for optimum management of this complication. Exclusion of a leak early can result in a shorter hospital stay . Desirable qualities of a good clinical diagnostic tool should include being easily accessible, cost effective and easily interpretable .…”

“…Exclusion of a leak early can result in a shorter hospital stay. 4 Desirable qualities of a good clinical diagnostic tool should include being easily accessible, cost effective and easily interpretable. 5 C-reactive protein (CRP) has been a promising serum indicator for the detection of post-operative anastomotic leaks in colorectal surgery.…”

Predicting Readmission and Leak Rates Following Colectomy with Red Cell Distribution Width: A Simple but Effective Test

“…There have been other studies, specifi cally regarding C-reactive protein (CRP) to try and achieve similar predictive models after colectomy. Krapta et al [15]. Demonstrated that non-elevation of CRP was able to accurately predict shorter length of hospital stay (p<0.01) with average CRP values of 6.3 in those with a LOS < 3 days, vs 11.7 in those with LOS > 4 days.…”

The effect of low dietary inflammatory index score formula on inflammatory, metabolic, and clinical outcomes in critically ill traumatic brain injury patients: A single‐blind randomized controlled pilot study

“…This is consistent with our other findings on reducing the level of inflammation and the severity of the disease in the ICU. Similarly, a study of 193 patients who underwent colorectal surgery found that lower hs‐CRP levels on the second postoperative day (POD2) were associated with a shorter hospital LOS (Krpata et al, 2013 ).…”