Complementary Roles of PCT, CRP, WBC, and ΔWBC in Early Leak Detection After Bariatric Surgery: A Retrospective Pilot...

Postoperative leakage is a critical complication after bariatric surgery, necessitating early and accurate detection. Conventional markers such as C-reactive protein (CRP) and white blood cell (WBC) counts are often limited by low specificity due to nonspecific inflammatory responses. Procalcitonin (PCT), a marker more specific to bacterial infections, may improve diagnostic reliability. This study compared the diagnostic performance of PCT with that of CRP, WBC, and ΔWBC (postoperative-preoperative difference) to enhance postoperative surveillance.

We retrospectively analyzed 579 bariatric surgery patients. Diagnostic performance was assessed via sensitivity, specificity, likelihood ratios, and confidence intervals. For group comparisons, the Kruskal-Wallis test and Fisher's exact test were used. Spearman's rank correlation was used to examine associations with clinical variables. Hospital stay and complication rates were also evaluated under a PCT-centered protocol.

PCT had the highest specificity (98.4%) compared with CRP (94.3%) and WBC (67.7%), although sensitivity was limited (33.3%) because of the low incidence of leaks (n = 3). PCT remained specific to one anastomosis gastric bypass (OAGB), whereas the CRP level and WBC count were influenced by baseline inflammation. In revision surgeries, specificity decreased across all markers, but ΔWBC retained strong performance (92%). The PCT-based protocol was associated with shorter hospital stays (22.0 vs. 25.0 h, p < 0.001) without increased complication rates.

PCT is a highly specific early marker for complications after bariatric surgery. When combined with conventional markers, particularly ΔWBC, it may support more efficient patient management. Further validation in broader clinical settings is warranted.