Can Elevated C-Reactive Protein Predict Postoperative Infection?

Clean-contaminated surgical sites are typically followed by infection, often with microbial contaminants from the wound. After colorectal surgery, postoperative infectious complications are the most common complications, as anastomotic leakage occurs in up to 40 percent of cases, and surgical site infection occurs in up to 10 percent of elective cases and 30 percent of emergency cases.

These infections consume healthcare dollars, and recently, studies have shown that they also predict poor long-term outcomes for patients. Experts have indicated that patients’ preoperative conditions — such as nutritional status, age, smoking, and comorbidities — can predispose them to infection, as can the degree of contamination, operative time, and blood loss.

Acknowledging that C-reactive protein (CRP) is a known infection or inflammation indicator, a team of researchers investigated preoperative CRP level’s predictive value with regard to postoperative infectious complications after colorectal surgery. They identified a retrospective cohort of patients at a single institution (n=464) who had undergone colorectal resection through laparotomy between April 2010 and March 2012.

The results of their analysis found that preoperative CRP levels and blood loss during surgery were independent risk factors for postoperative infectious complications. For every 1 mg/dL increase in CRP, the odds ratio of postoperative infect was 1.17, while for every 100 g of blood lost, the odds ratio was 1.13.

Thus, the researchers suggested that colorectal surgeons should observe patients who have elevated preoperative CRP levels carefully.