Background: Postoperative leak and intra-abdominal infections are common after bariatric surgery with a significant impact on perioperative outcomes, hospital length of stay, and readmission rates. In the era of enhanced recovery programs, with patients being discharged from the hospital 24–36 h after surgery and potentially before developing any complications, an early indicator of postoperative complications may be decisive. The aim of this study was to evaluate the predictive role of the C-reactive protein (CRP) in the early diagnosis of complications in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods: PubMed, Embase, and Web of Science databases were consulted. A systematic review and a fully Bayesian meta-analysis were conducted. Results: Seven studies met the inclusion criteria for a total of 1401 patients. Overall, 57.7% underwent LSG while 42.3% underwent LRYGB. The pooled prevalence of postoperative complications was 9.8% (95% CI = 5–16%). The estimated pooled CRP cut-off value on postoperative day 1 (POD1) was 6.1 mg/dl with a significant diagnostic accuracy and a pooled area under the curve of 0.92 (95% credible interval (CrI) 0.73–0.98). The positive and negative likelihood ratios were 13.6 (95% CrI 8.40–15.9) and 0.16 (95% CrI 0.04–0.31), respectively. Conclusion: A CRP value lower than the derived cut-off of 6.1 mg/dl on POD1, combined with reassuring clinical signs, could be useful to rule out early postoperative leak and complications after LSG and LRYGB. In the context of enhanced recovery after surgery protocols, the integration of a CRP-based diagnostic algorithm as an additional complementary instrument may be valuable to reduce cost and improve outcomes and patient care.

Does C-reactive protein have a predictive role in the early diagnosis of postoperative complications after bariatric surgery? Systematic review and bayesian meta-analysis / D. Bona, G. Micheletto, G. Bonitta, V. Panizzo, M. Cavalli, E. Rausa, S. Cirri, A. Aiolfi. - In: OBESITY SURGERY. - ISSN 0960-8923. - 29:11(2019 Jun 22), pp. 3448-3456. [10.1007/s11695-019-04013-0]

Does C-reactive protein have a predictive role in the early diagnosis of postoperative complications after bariatric surgery? Systematic review and bayesian meta-analysis

D. Bona
Primo
;
G. Micheletto
Secondo
;
V. Panizzo;E. Rausa
Penultimo
;
A. Aiolfi
Ultimo
2019

Abstract

Background: Postoperative leak and intra-abdominal infections are common after bariatric surgery with a significant impact on perioperative outcomes, hospital length of stay, and readmission rates. In the era of enhanced recovery programs, with patients being discharged from the hospital 24–36 h after surgery and potentially before developing any complications, an early indicator of postoperative complications may be decisive. The aim of this study was to evaluate the predictive role of the C-reactive protein (CRP) in the early diagnosis of complications in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods: PubMed, Embase, and Web of Science databases were consulted. A systematic review and a fully Bayesian meta-analysis were conducted. Results: Seven studies met the inclusion criteria for a total of 1401 patients. Overall, 57.7% underwent LSG while 42.3% underwent LRYGB. The pooled prevalence of postoperative complications was 9.8% (95% CI = 5–16%). The estimated pooled CRP cut-off value on postoperative day 1 (POD1) was 6.1 mg/dl with a significant diagnostic accuracy and a pooled area under the curve of 0.92 (95% credible interval (CrI) 0.73–0.98). The positive and negative likelihood ratios were 13.6 (95% CrI 8.40–15.9) and 0.16 (95% CrI 0.04–0.31), respectively. Conclusion: A CRP value lower than the derived cut-off of 6.1 mg/dl on POD1, combined with reassuring clinical signs, could be useful to rule out early postoperative leak and complications after LSG and LRYGB. In the context of enhanced recovery after surgery protocols, the integration of a CRP-based diagnostic algorithm as an additional complementary instrument may be valuable to reduce cost and improve outcomes and patient care.
C-reactive protein; Fast-track surgery; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic sleeve gastrectomy; Postoperative complications
Settore MED/18 - Chirurgia Generale
22-giu-2019
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/658486
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