C-reactive protein for detection of colorectal anastomotic leakage and safer early discharge

Colorectal anastomotic leakage is associated with increased mortality, need for reoperation, diverting stomas, delayed discharge and higher costs. Early detection of anastomotic leaks can significantly impact morbidity and clinical outcomes. The aim of this study is to identify the role of C-reactive protein (CRP) in the early detection of anastomotic leakage to improve treatment and fasten rehabilitation.

This is a prospective study that included 180 patients submitted to colectomies at AC Camargo Cancer Center from October 2021 to December 2022. C-reactive protein was systematically assessed on the third day after surgery. Postoperative care was provided by a single colorectal team based on our protocol for early recovery, which includes early feeding and mobilization, opioid avoidance and antibiotic prophylaxis.

180 patients were included in the study, comprising 79 women and 101 men, with a mean age of 62 years. Eighteen out of 180 patients presented with anastomotic leakage (10%). Analyzing the ROC curve for CRP, the area under the curve (AUC) was 0.860. The cutoff value was 11.2mg/dL, with an ROC of 0.81, resulting in a sensitivity of 77.8% and specificity of 84.0%. The negative predictive value (NPV) was 97.1%. An alternative cutoff with higher accuracy was 15.0mg/dL which has NPV of 96.1%, and more clinical applicability.

A postoperative CRP of less than 15.0mg/dL, measured on the 3rd postoperative day, was effective in predicting a low risk of anastomotic leakage on asymptomatic patients allowing safe early discharge.