Early Postoperative C-Reactive Protein Trajectories After Thoracic Surgery: A Retrospective Cohort Study

Area of Science:

• Thoracic Surgery
• Biomarkers
• Inflammation and Infection

Background:

• Differentiating postoperative inflammation from infection after thoracic surgery is clinically challenging.
• Serial C-reactive protein (CRP) measurements are commonly employed to assist in this differentiation.
• Understanding CRP trajectories is crucial for timely diagnosis and management of complications.

Purpose of the Study:

• To analyze C-reactive protein (CRP) trajectories following thoracic surgery.
• To compare CRP levels based on surgical approach (VATS vs. open thoracotomy) and extent of resection.
• To identify potential thresholds for CRP elevation indicative of complications.

Main Methods:

• Retrospective cohort study of 144 adult thoracic surgery patients.
• Serial CRP measurements from preoperative to postoperative day 5.
• Statistical analysis using repeated-measures ANOVA to compare CRP trajectories across different surgical factors.

Main Results:

• Overall CRP peaked around postoperative day 2 (200.9 ± 72.7 mg/L) and subsequently declined.
• Higher CRP peaks were observed with open thoracotomy and more extensive resections (e.g., pneumonectomy), though not statistically significant.
• Patients with infections showed prolonged CRP elevation (>100 mg/L beyond POD4) compared to uncomplicated cases, but this trend lacked statistical significance.

Conclusions:

• Postoperative CRP in thoracic surgery typically peaks at 48-72 hours and then falls.
• While trends suggest higher CRP with open surgery and extensive resection, further validation is needed.
• Persistent CRP elevation above 100 mg/L after postoperative days 3-4 may signal complications, necessitating closer surveillance.