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2013 | 85 | 4 | 198-203
Tytuł artykułu

Evaluation of inflammatory markers as predictors of hospital stay and unplanned readmission after colorectal surgery

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
Hospital length of stay (LOS) and readmissions continue to be expensive and unexpected events following colorectal surgery (CRS) whether patients follow enhanced recovery pathways or traditional care. Predictors of these adverse events could facilitate identification and optimization of CRS patients. The aim of the study was to examine the impact of white blood cell count (WBC) and C-reactive protein (CRP) levels as predictors of delayed recovery or hospital readmission following CRS. Material and methods. Patients undergoing laparoscopic or open abdominal colorectal surgery by a single surgeon were managed using standardized enhanced recovery pathways. Those with postoperative day 2 CRP and white blood cell values were evaluated. Outcomes included 30-day hospital readmission rates and postoperative length of hospital stay. Results. CRP values were available for 193 patients (86 Male, mean age 58.6 years). Ninety-nine patients had surgery for colon cancer, 23 for Crohn’s disease, 19 for ulcerative colitis, 31 for diverticulitis and 18 for other reasons. Twenty patients (10.4%) were readmitted to the hospital within 30 days of surgery. POD2 CRP accurately predicted short length of hospital stay (p< 0.01). Average CRP was 6.3 in the LOS of < 3 days or less, and 11.7 in patients with LOS >4 days. The mean CRP of the readmission and non-readmission groups was 11.8 and 9.9, respectively (p=0.29). The average POD 2 WBC of the readmission and non-readmission groups was 10.6 and 9 respectively (p=0.01). Conclusion. A low POD2 CRP level was correlated with a shorter LOS, but it did not predict readmission. Conversely, POD2 WBC, and the difference in WBC from baseline were associated with readmission. These markers may be useful indicators to predict suitability of early discharge in an ERP. Further evaluation in prospective trials is warranted.
Wydawca

Rocznik
Tom
85
Numer
4
Strony
198-203
Opis fizyczny
Daty
wydano
2013-04-01
online
2013-05-01
Twórcy
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
autor
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
autor
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
  • Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio Kierownik: C. P. Delaney, MD MCh PhD FRCSI FACS FASCRS
Bibliografia
  • 1. Goodney PP, Stukel TA , Lucas FL et al.: Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003; 238: 161-67.
  • 2. Kariv Y, Wang W , Senagore AJ et al.: Multivariable analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg 2006; 191: 364-71.
  • 3. Kiran R P, Delaney CP, Senagore AJ et al.: Outcomes and prediction of hospital readmission after intestinal surgery. JAm Coll Surg 2004; 198: 877-83.
  • 4. O’Brien DP, Senagore A , Merlino J et al.: Predictors and outcome of readmission after laparoscopic intestinal surgery. World JSurg 2007; 31: 2430-35.[WoS]
  • 5. Andersen J , Hjort-Jakobsen D, Christiansen PS,Kehlet H: Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg 2007; 94: 890-93.
  • 6. Delaney CP: Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. DisColon Rectum 2008; 51: 181-85.
  • 7. Guinier D, Mantion GA , Alves A et al.: Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis ColonRectum 2007; 50: 1316-23.
  • 8. Kariv Y, Delaney CP, Senagore AJ et al.: Clinical outcomes and cost analysis of a „fast track” postoperative care pathway for ileal pouch-anal anastomosis: a case control study. Dis Colon Rectum 2007; 50: 137-46.
  • 9. Teeuwen PH, Bleichrodt R P, Strik C et al.: Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 2010; 14: 88-95.[Crossref][PubMed]
  • 10. Varadhan KK, Neal KR, Dejong CH et al.: The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010; 29: 434-40.
  • 11. Adamina M, Kehlet H, Tomlinson GA et al.: Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011; 149: 830-40.
  • 12. Volanakis J E: Human C-reacti ve protein: expression, structure, and functi on. Mol Immunol 2001; 38(2-3): 189-97.[Crossref]
  • 13. Korner H, Nielsen HJ, Soreide JA et al.: Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections. JGastrointest Surg 2009; 13: 1599-1606.[Crossref]
  • 14. Welsch T , Muller SA , Ulrich A et al.: C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J ColorectalDis 2007; 22: 1499-1507.
  • 15. Cappabianca G , Paparella D, Visicchio G et al.: Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery. Ann Thorac Surg 2006 Dec; 82(6): 2170-78.
  • 16. Nunes B K, Lacerda RA , Jardim J M: Systematic review and meta-analysis of the predictive value of C-reactive protein in postoperative infections). Rev Esc Enferm US P 2011; 45(6): 1488-94.
  • 17. Erlinger T P, Platz EA, Rifai N, Helzlsouer KJ: C-reactive protein and the risk of incident colorectal cancer. JAMA 2004; 291: 585-90.
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_pjs-2013-0030
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