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
Por:
Ruiz-Tovar J, Muñoz JL, Gonzalez J, Garcia A, Ferrigni C, Jimenez M and Duran M
Publicada:
1 dic 2017
Ahead of Print:
7 jun 2017
Categoría:
Surgery
Resumen:
The performance of most bariatric procedures within an Enhanced Recovery After Surgery program has resulted in significant advantages, including a reduction in the length of hospital stay to 2-3 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 h after a laparoscopic sleeve gastrectomy for predicting staple line leak in the postoperative course.
A prospective study of 208 morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2012 and 2015 was performed. Blood analysis was performed 24 h after surgery. Acute-phase parameters (C-reactive protein, procalcitonin, fibrinogen, and White Blood Cell count) were investigated.
Staple line leak appeared in eight patients (3.8%). Using receiver operating characteristic analysis at 24 h postoperatively, a cutoff level of CRP at 9 mg/dL achieved 85% sensitivity and 90% specificity for predicting staple line leak, a cutoff level of procalcitonin at 0.85 ng/mL achieved 70% sensitivity and 90% specificity, and a cutoff level of fibrinogen at 600 mg/dL achieved 80% sensitivity and 87.5% specificity.
An elevation of CRP > 9 mg/dL, procalcitonin > 0.85 ng/mL and fibrinogen > 600 mg/dL should alert the surgeon the possibility of occurrence of postoperative staple line leak.
Filiaciones:
:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain.
:
Department of Anesthesia, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
Gonzalez J:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain
Garcia A:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain
Ferrigni C:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain
Jimenez M:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain
Duran M:
University Hospital Rey Juan Carlos, Gladiolo s/n, 28933, Móstoles, Madrid, Spain
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