scholarly journals Thrombocytosis as a Marker for Postoperative Complications in Colorectal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
M. Mohamud ◽  
L. Osborne ◽  
H. G. Jones ◽  
A. Ahmed ◽  
J. Beynon ◽  
...  
Keyword(s):  
Platelet Count ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Surgical Complications ◽  
Incidental Finding ◽  
Blood Platelet ◽  
Prognostic Indicator ◽  
Categorical Variables ◽  
Elective Colorectal Surgery ◽  
Positive Correlation

Background. Blood platelet measurement is a widely available and inexpensive test that is performed routinely. Platelets are thought to act by inducing inflammation and play a role in clotting and antimicrobial defence. A postoperative rise in the platelet count (thrombocytosis) is often dismissed as an incidental finding, but there is growing evidence to suggest that it may act as an indicator to underlying pathology. It correlates with significant pyogenic infections as well as multiple malignancies. In addition to this, recent research indicates that thrombocytosis may be a useful prognostic indicator for postoperative outcomes in patients with malignancies. In patients undergoing surgery for gastric cancer, a combination of platelet count and neutrophil-to-lymphocyte (NLR) ratio collected preoperatively was shown to correlate with postoperative survival. Objective. To evaluate whether there is a positive correlation between pre- and postoperative thrombocytosis and the risk of complications following colorectal surgery. Methods. This was a retrospective observational study based in Morriston Hospital, Swansea. Patients undergoing elective colorectal surgery for an 18-month period between 2014 and 2016 were included. Data on patient demographics, pre- and postoperative platelet count, the first date at which the highest platelet count was recorded, length of stay, type of operation, and postoperative complications using the Clavien-Dindo classification was obtained from the theatre booking software (TOMS) and Welsh Clinical Portal. Pearson’s chi-square test was used for the analysis of the categorical variables. Results. Of the 201 patients studied, 75 (37%) had postoperative thrombocytosis (platelets ≥ 500 × 109/L, range 501–1136), 120 (59%) had postoperative normocytosis (platelets < 500 × 109/L, range 107–499), and 6 (2.9%) patients were excluded due to insufficient data. Peak platelet level was seen at a median of 8 days postoperatively but ranged from days 1 to 49. In patients with thrombocytosis, the mean time to peak platelet count was 9.5 days and ranged 1 to 49 days. 101/195 (52%) patients had a Clavien-Dindo III/V postoperative complication: 63% patients with postoperative normocytosis and 24% with postoperative thrombocytosis. In the thrombocytosis group, 16/75 (21%) were found to have postoperative pelvic collections compared to 1/120 (0.8%) of the normocytic patients. The total percentage of medical complications (44% versus 20%, p=0.006) and surgical complications (64% versus 15.8%, p=0.0001) was higher in the thrombocytosis group compared to the normocytosis group. Conclusion. In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.

Frailty predicts severe postoperative complications after elective colorectal surgery

2019 ◽  
Vol 217 (4) ◽  
pp. 677-681 ◽  
Author(s):  
Hirohisa Okabe ◽  
Takayuki Ohsaki ◽  
Katsuhiro Ogawa ◽  
Nobuyuki Ozaki ◽  
Hiromitsu Hayashi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Elective Colorectal Surgery

scholarly journals Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

2021 ◽  
Author(s):  
Sufana Alsaif ◽  
Ailín C Rogers ◽  
Priscilla Pua ◽  
Paul T Casey ◽  
Geoff G Aherne ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Inflammatory Markers ◽  
Postoperative Morbidity ◽  
Colorectal Neoplasia ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Elective Colorectal Surgery ◽  
Reactive Protein ◽  
Grade 3

Abstract Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

Effects of Intravenous Fluid Restriction on Postoperative Complications

2018 ◽  
pp. 119-124
Keyword(s):  
Body Weight ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Intravenous Fluid ◽  
Standard Group ◽  
Fluid Restriction ◽  
Standard Regimen ◽  
Elective Colorectal Surgery ◽  
Thoracic Epidural ◽  
Fluid Regimen

This case focuses on the effects of limiting intravenous fluids on postoperative complications by asking the question: What are the effects of a restricted intravenous fluid regimen targeting an unchanged body weight vs. a standard regimen on complications after elective colorectal surgery? Patients receiving combined thoracic epidural and general anesthesia were randomized to two groups: the restricted fluid regimen and the standard fluid regimen. A total of 141 patients completed the trial: 69 in the restricted group and 72 in the standard group. This randomized, observer-blinded clinical trial demonstrated that a restricted intravenous fluid regimen aimed at unchanged body weight reduced complications after elective colorectal surgery.

scholarly journals Limited preoperative physical capacity continues to be associated with poor postoperative outcomes within a colorectal ERAS programme

2019 ◽  
Vol 101 (4) ◽  
pp. 261-267 ◽  
Author(s):  
E McLennan ◽  
R Oliphant ◽  
SJ Moug
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Patient Outcomes ◽  
Univariate Analysis ◽  
Lifestyle Factors ◽  
Physical Capacity ◽  
Elective Colorectal Surgery

Aim Enhanced recovery after surgery (ERAS) programmes aim to standardise perioperative care leading to optimal patient outcomes. Despite these programmes, variation in outcomes still persists. This study aimed to assess the influence of lifestyle factors on short-term outcomes after colorectal surgery within this optimal recovery programme. Methods Consecutive patients enrolled on an ERAS pathway who underwent elective colorectal surgery (June 2013 to July 2014) at one site were included. We used data routinely collected by ERAS nurse specialists and during preassessment to analyse association between patient and lifestyle factors and likelihood of developing postoperative complications or having an increased length of stay. Results A total of 199 patients were included: mean age 61.8 years (range 17–90 years) and 53.8% male. Age, sex, deprivation, smoking status, alcohol intake, body mass index or level of comorbidity were not associated with postoperative complications. Patients reporting limited preoperative physical capacity (unable to climb two flights of stairs) were more than four times as likely to have a postoperative complication on univariate analysis and were found to still have increased risk of postoperative complications on multivariate analysis. Patients reporting limited preoperative physical capacity were shown to have significantly longer hospital stay on univariate analysis. In the multivariate analysis, limited physical capacity was not associated with prolonged length of stay due to confounding factors of age and deprivation. Conclusions Limited physical capacity was the only patient and lifestyle factor associated with poorer postoperative complications and prolonged hospital stay after elective colorectal surgery within an ERAS programme. Consideration should be given to individualised prehabilitation that aims to increase physical capacity pre-operatively to improve patient outcomes.

scholarly journals Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sufana H. Alsaif ◽  
Ailín C. Rogers ◽  
Priscilla Pua ◽  
Paul T. Casey ◽  
Geoff G. Aherne ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Inflammatory Markers ◽  
Postoperative Morbidity ◽  
Colorectal Neoplasia ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Elective Colorectal Surgery ◽  
Reactive Protein ◽  
Grade 3

Abstract Background Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods This is a retrospective study which catalogs 218 patients undergoing elective, potentially curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6, and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC = 0.871), and values above 17.5 mg/L predicted severe complications (AUC = 0.934). Conclusions Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

scholarly journals Preoperative C-Reactive Protein as A Predictor of Postoperative Complications in Patients Undergoing Surgery for Colorectal Neoplasia

2020 ◽  
Author(s):  
Sufana Alsaif ◽  
Ailín C Rogers ◽  
Priscilla Pua ◽  
Paul T Casey ◽  
Geoff G Aherne ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Colorectal Neoplasia ◽  
Multivariable Analysis ◽  
Full Blood Count ◽  
C Reactive Protein ◽  
Elective Colorectal Surgery ◽  
Reactive Protein ◽  
Grade 3

Abstract Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

C-Reactive Protein as a Marker for Postoperative Complications. Are There Differences in Emergency and Elective Colorectal Surgery?

2016 ◽  
Vol 59 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Jennifer Straatman ◽  
Elizabeth de Wijkerslooth de Weerdesteijn ◽  
Jurriaan B. Tuynman ◽  
Miguel A. Cuesta ◽  
Donald L. van der Peet
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
C Reactive Protein ◽  
Elective Colorectal Surgery ◽  
Reactive Protein

scholarly journals Albumin and CRP, Which is the Best Biomarker for Postoperative Complications on Colorectal Surgery? Prospective Cohort Study

2021 ◽  
Author(s):  
Miguel Fernandes Cunha ◽  
Beatriz Mendes ◽  
Pedro Mendanha ◽  
Ines Miguel ◽  
Juan Rachadell ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Predictive Marker ◽  
Elective Colorectal Surgery ◽  
Predictive Values

Abstract Aim Our purpose was to investigate the potential role of albumin variation in comparison to C-reactive protein (CRP) variation as a predictive marker for postoperative complications in colorectal surgery. Methods An prospective cohort study was conducted. Adult patients who underwent elective colorectal surgery between January 2019 and December 2020 were eligible. Serum levels of albumin and CRP were measured preoperatively and on the first 4 postoperative days. Univariate analysis were performed to assess the association of albumin (Alb) and CRP with postoperative complications. Serum albumin variation (ΔAlb) and CRP variation (ΔCRP) were calculated. Receiver operating characteristic curve analysis and the Youden test were used to determine acuity and predictive cut-off values. Results Ninety-three patients were included. A CRP cut-off of 83.4 mg/dL on postoperative day (POD) 4 was the best predictor of postoperative global complications (p<0.001; AUC 0.83, 70% sensitivity, 91% specificity). Major complications were best correlated with ΔAlb on POD 2, 3 and 4 (p<0.001), with a ΔAlb cut-off of 27.4% on POD 2 showing the strongest association with this outcome (AUC 0.834, 83% sensitivity, 90% specificity). Regarding anastomotic leak, CRP on POD 3 showed better predictive values (p=0.037; AUC 0.792) with a cut-off value of 88.7 mg/dL (100% sensitivity, 52% specificity). Discussion Herein, the authors demonstrate there is a role for albumin variation, as an earlier and sensitive marker, to predict major postoperative complications in colorectal surgery. This analysis may be further applied to aid in the early identification of significant causes of re-operation and long-term morbimortality.

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