C-reactive protein kinetics post elective cranial surgery. A prospective observational study.

Area of Science:

• Neurosurgery
• Infectious Disease
• Clinical Pathology

Background:

• Post-cranial surgery readmissions are often due to surgical site infections (SSI).
• Current discharge assessments rely on clinical recovery and basic labs like C-reactive protein (CRP).
• The predictive value of CRP kinetics for SSI post-craniotomy requires further investigation.

Purpose of the Study:

• To evaluate C-reactive protein (CRP) as a standalone predictor of surgical site infection (SSI) in patients undergoing elective cranial surgery.
• To assess the utility of CRP kinetics and specific thresholds for predicting safe discharge and identifying potential SSIs.
• To compare the predictive value of CRP with other inflammatory markers for SSI.

Main Methods:

• A prospective observational study included 68 adult patients undergoing elective cranial surgery.
• Pre- and post-operative laboratory data (CRP, WCC, NCC) and clinical data were collected.
• Readmission rates within one month were monitored to identify SSIs.

Main Results:

• 8.6% of patients were readmitted due to SSI.
• A secondary CRP rise on postoperative day 5 predicted SSI with 71% sensitivity and 90% specificity.
• A CRP value below 65 on day 5 predicted safe discharge with 86% sensitivity and 98% negative predictive value (AUC: 0.782).

Conclusions:

• Postoperative CRP elevation for 4-5 days is a physiological response; however, a secondary rise or prolonged elevation suggests infection.
• CRP levels show potential as a reliable indicator for predicting SSI after cranial surgery.
• Further multicenter studies are recommended to validate the role of CRP in SSI prediction.