Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy

Abstract

INTRODUCTION Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy. METHODS Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter. RESULTS During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2-86 years) and a mean C-reactive protein (CRP) level of 71mg/l (range: 0-480mg/l) while the LCOA group had a mean age of 46 years (range: 11-92 years) and a mean CRP level of 162mg/l (range: 3-404mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150mg/l (p<0.05). CONCLUSIONS A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150mg/l.

The Value of C-Reactive Protein in Enhancing Diagnosis of Acute Appendicitis

“…Necrotizing group of our patients though small but had consistent high values of both CRP and WBC and parallel rise providing provisional evidence of emergent treatment in this group to avoid the consequences of perforation and its morbidity. Some studies have debated and suggestion has been made to offer these patients open surgery right from beginning in order to avoid postoperative complications of established infection and collection [15]. In this study procedures were mainly laparoscopic though the figures were small.…”

A clinical study of generalised peritonitis and its management in a rural setup

“…Shelton J et al reported that a CRP level of >150mg/L is associated with increased complication rate postoperatively. 33 Suh S et al reported that serum CRP levels are sensitive markers to differentiate a perforated from non-perforated appendicitis. They found mean CRP levels in patients with perforated appendicitis was 43.4 mg/L while in non-perforated appendicitis was 11.88 mg/L.…”

Abscess After Appendectomy

“…Gender, age, symptom duration, fever greater than 38 C, cecectomy, saline peritoneal irrigation, and presence or absence of a drain were not significantly associated with IAA formation. Other investigators have found the data regarding predictive value of WBC less convincing [17,18,29]. These data are summarized in Table 3.…”

“…Preoperative CRP Thereaux et al [28], 2014 >200 mg/L is predictive of IAA (OR 16.4, P ¼ .02) Shelton et al [29], 2014 >150 mg/L is predictive of postoperative complication a Preoperative WBC Thereaux et al [28], 2014 >17,000 mm À3 is predictive of IAA (OR 25.0, P ¼ .007) Shelton et al [29], 2014 Not predictive of postoperative complication a Kelly et al [18] time to surgery increases rates of perforation and, therefore, the rates of postoperative abscess. A recent review confirmed that delaying operative intervention for greater than 12 hours increases the rates of perforation and postoperative IAA [30].…”