C-reactive protein for predicting early postoperative complications in patients undergoing laparoscopic shaving for deep infiltrating endometriosis.

Abstract

STUDY OBJECTIVE\nTo assess the accuracy of C-reactive protein (CRP) in predicting early postoperative complications in patients undergoing elective laparoscopic shaving for rectosigmoid deep infiltrating endometriosis (DIE).\n\n\nDESIGN\nA single-centre observational retrospective cohort study.\n\n\nSETTING\nThird-level referral center for endometriosis PATIENTS: Two hundred ninety-four patients were included in the study. All of them underwent elective laparoscopic shaving for rectosigmoid DIE.\n\n\nINTERVENTIONS\nPostoperative CRP levels (assessed from day 3 and every 48 hours till hospital discharge) and early postoperative complications were reviewed to assess CRP as a predictive marker of postoperative complications.\n\n\nMEASUREMENTS AND MAIN RESULTS\nStudy outcomes were the association between early postoperative complications and CRP levels, the optimal CRP cut-off, and its predictive accuracy. Twenty-five patients (8.5%) experienced early postoperative complications. Five patients with postoperative complications within 2 days of surgery were excluded from the analysis. On postoperative day 3, the difference in the means of CRP between patients with and without complications was 2.5 mg/dL, while at day 5 the difference was 5.3 mg/dL, with a significant increase of 2.8 mg/dL. On postoperative day 7, the difference was 11.4 mg/dL, with a further increase of 6.1 mg/dL from day 5. Mean CRP in the group with complications increased of 1.2 mg/dL from day 3 to day 5, and of 6.2 mg/dL from day 5 to day 7. The optimal cut-off for CRP in predicting early postoperative complications was 3.1 mg/dl on postoperative day 3 and 5.2 mg/Dl on postoperative day 5, with a sensitivity of 87.5% and 80%, a specificity of 62.5% and 91.2%, a positive predictive value of 17.5% and 44.4%, a negative predictive value of 98.2% and 98.1%, and an AUC of 75.0% and 85.6%, respectively.\n\n\nCONCLUSION\nCRP on postoperative day 5 appeared as a moderately accurate predictive marker of early postoperative complications in patients who underwent elective laparoscopic shaving for rectosigmoid DIE.