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Roux A, David V, Bardet M S, Auditeau E, Durand Fontanier S, Taibi A. Predictive value of C-reactive protein levels for the early and later detection of postoperative complications after cytoreductive surgery and HIPEC. Front Oncol 2022; 12:943522. [DOI: 10.3389/fonc.2022.943522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
SynopsisC-reactive protein (CRP), white blood cells and procalcitonin (PCT) participate in the systemic response to inflammation and increase after postoperative infective complications. Postoperative complications after CRS and HIPEC could be predicted using the CRP cut-off value (169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10).BackgroundPostoperative elevation of C-reactive protein (CRP) can be used in order to predict the postoperative complications in many indications. Cytoreduction surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity.ObjectivesThe aim of the study was to demonstrate the CRP predictive value for the occurrence of complications.MethodsAll patients who had CRS and HIPEC, regardless of the origin of peritoneal metastasis, were included in this retrospective study. Postoperative complications and CRP and white blood cell (WBC) counts were recorded from postoperative day (POD) 1 through 10.ResultsAmong the 127 patients included, 58 (45.7%) had no complications (NCs), 53 (41.7%) had infective complications (ICs), and 16 (12.6%) had non-infective complications (NICs). The IC group had a higher CRP value than the NC group, which was statistically significant from POD7 to POD10 (41.1 versus 107.5 p = 0.023 and 77.8 versus 140 p = 0.047, respectively). A cut-off CRP value was 169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10. The area under the curve (AUC) at POD5 was 0.56 versus 0.76 at POD7, p=0.007. The sensibility, specificity, positive and negative predictive values of these cut-offs were 55%, 83%, 74% and 67%, respectively. Moreover, 17 patients (32%) with ICs had a CRP value higher than these cut-offs before the diagnosis was made by the medical team.ConclusionThis study suggested that postoperative complications could be predicted using the CRP cut-off value on PODs 3-5 (169 mg/l) and PODs 7-10 (62 mg/l) after CRS and HIPEC.
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Schena CA, de’Angelis GL, Carra MC, Bianchi G, de’Angelis N. Antimicrobial Challenge in Acute Care Surgery. Antibiotics (Basel) 2022; 11:antibiotics11101315. [PMID: 36289973 PMCID: PMC9598495 DOI: 10.3390/antibiotics11101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/07/2022] Open
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Correspondence:
| | - Maria Clotilde Carra
- Rothschild Hospital, AP-HP, Université Paris Cité, U.F.R. of Odontology, 75006 Paris, France
| | - Giorgio Bianchi
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
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Plat VD, Voeten DM, Daams F, van der Peet DL, Straatman J. C-reactive protein after major abdominal surgery in daily practice. Surgery 2021; 170:1131-1139. [PMID: 34024474 DOI: 10.1016/j.surg.2021.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infectious complications are frequently encountered after abdominal surgery. Early recognition, diagnosis, and subsequent timely treatment is the single most important denominator of postoperative outcome. This study prospectively addressed the predictive value of routine assessment of C-reactive protein levels as an early marker for infectious complications after major abdominal surgery. METHODS Consecutive patients undergoing major abdominal surgery between November 2015 and November 2019 were prospectively enrolled. Routine C-reactive protein measurements were implemented on postoperative days 3, 4, and 5, and additional computed tomography examinations were performed on demand. The primary endpoint was the occurrence of Clavien-Dindo grade III or higher infectious complications. RESULTS Of 350 patients, 71 (20.3%) experienced a major infectious complication, and median time to diagnosis was 7 days. C-reactive protein levels were significantly higher in patients with major infectious complications compared to minor or no infectious complications. The optimal cut-off was calculated for each postoperative day, being 175 mg/L on day 3, 130 mg/L on day 4, and 144 mg/L on day 5, and corresponding sensitivities, specificities, and positive and negative predictive values were over 80%, 65%, 40%, and 92% respectively. Alternative safe discharge cut-offs were calculated at 105 mg/L, 71 mg/L and 63 mg/L on days 3, 4, and 5, respectively, each having a negative predictive value of over 97%. CONCLUSION The C-reactive protein cut-offs provided in this study can be used as a discharge criterion or to select patients that might require an invasive intervention due to infectious complications. These diagnostic criteria can easily be implemented in daily surgical practice.
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Affiliation(s)
- Victor D Plat
- Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands.
| | - Daan M Voeten
- Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Freek Daams
- Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands
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Herrero A, Gonot Gaschard M, Bouyabrine H, Perrey J, Picot MC, Guillon F, Fabre JM, Souche R, Navarro F. Comparative study of biological versus synthetic prostheses in the treatment of ventral hernias classified as grade II/III by the Ventral Hernia Working Group. J Visc Surg 2021; 159:98-107. [PMID: 34020911 DOI: 10.1016/j.jviscsurg.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY The implantation of biological prostheses in an at-risk environment has seen increasing use. Their markedly higher cost compared to synthetic prostheses makes it important to analyse their usefulness in terms of actual benefit and cost-effectiveness. This study aims to examine the relevance of bioprostheses during surgical repair of Grade II/III ventral hernias as classified by the Ventral hernia working group (VHWG). MATERIALS AND METHODS This study analysed the data of 119 patients requiring non-emergency repair of VHWG II/III grade hernias between 2010 and 2017. The results of patients who were treated with a bioprosthesis (n=59) were compared to those receiving a synthetic prosthesis (n=60). The primary outcome was surgical site infection (SSI) at 90 days. The secondary endpoints were hernia recurrence rate, cost of the prosthesis, duration of hospital stay and re-hospitalisation rate. RESULTS The two groups were shown to be comparable by analysis of demographic, pre- and intraoperative data. The SSI rate was significantly higher in the bioprosthesis group (20% vs. 7%; P=0.010), as was the recurrence rate (56% vs. 28%; P=0.003) with a median follow-up of 40 months. The cost of the bioprosthesis was significantly higher than that of the synthetic prosthesis (€3363 vs. €249; P<0.010). CONCLUSION In this retrospective study, the use of a bioprosthesis for repair of VHWG II/III ventral hernias was associated with a higher rate of both SSI and hernia recurrence at a cost 13 times greater than the use of a synthetic prosthesis.
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Affiliation(s)
- A Herrero
- Department of digestive surgery and liver transplantation, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - M Gonot Gaschard
- Department of digestive surgery and liver transplantation, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - H Bouyabrine
- Department of digestive surgery and liver transplantation, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - J Perrey
- Pharmacie euromédecine, CHU de Montpellier, correspondant local de matériovigilance, équipe des dispositifs médicaux stériles, 34295 Montpellier, France
| | - M-C Picot
- Department of medical information, Clinical research and epidemiology unit, hôpital de la Colombière, CHU de Montpellier, 34295 Montpellier, France
| | - F Guillon
- Department of digestive surgery, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - J-M Fabre
- Department of digestive surgery, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - R Souche
- Department of digestive surgery, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - F Navarro
- Department of digestive surgery and liver transplantation, University of Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Janet J, Derbal S, Durand Fontanier S, Bouvier S, Christou N, Fabre A, Fredon F, Rivaille T, Valleix D, Mathonnet M, Taibi A. C-reactive protein is a predictive factor for complications after incisional hernia repair using a biological mesh. Sci Rep 2021; 11:4379. [PMID: 33623063 PMCID: PMC7902654 DOI: 10.1038/s41598-021-83663-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
The introduction of biological or absorbable synthetic meshes has provided an alternative to conventional repair for incisional hernia. The ability to predict the development of complications after hernia surgery is important, as it guides surgical planning and patient management. This retrospective study assessed whether the postoperative C-reactive protein (CRP) level can predict complications after incisional hernia repair using biological mesh reinforcement. Patients who underwent incisional hernia repair surgery using biological meshes between February 2009 and February 2015 were screened for study inclusion. Patients included in the study were divided into two groups: those with and without postoperative complications. The two groups were analysed based on sex, surgical operation, length of intensive care unit stay (ICU), complications and mortality. Laboratory values, including white blood cell (WBC) count and CRP levels, were determined preoperatively and up to postoperative day (POD) 10. Postoperative complications requiring further management occurred in 32 of the 60 patients (53.3%). Among 47 patients, the mean CRP and WBC levels were 6.6 mg/L and 9.073 G/L in the group without complications vs. 141.0 mg/L, 16.704 G/L in the group with complications (p < 0.001). Patients with complications also had a longer ICU stay (10.1 vs. 0.6 days, p < 0.0001). A cut-off was 101 mg/L and offered 80.00% sensitivity (IC 61.43% to 92.29) and 95.24% specificity (76.18% to 99.88%) for postoperative complication. The rate of postoperative complications before POD10 was 95% in the group with CRP > 100 mg/L vs. 46% in the group with CRP < 100 mg/L (p = 0.000372). A high postoperative CRP level (> 100 mg/L) up to POD10 may serve as a predictor of postoperative complications in patients undergoing incisional hernia using biological meshes.
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Affiliation(s)
- Julien Janet
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Sophiane Derbal
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Sylvaine Durand Fontanier
- Visceral Surgery Department, Limoges University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Stephane Bouvier
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Niki Christou
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Anne Fabre
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Fabien Fredon
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Thibaud Rivaille
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Denis Valleix
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Muriel Mathonnet
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Abdelkader Taibi
- Visceral Surgery Department, Limoges University Hospital, Limoges, France. .,University Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France.
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The emerging predictive role of C-reactive protein after ventral hernia repair with mesh. Hernia 2020; 24:1415. [PMID: 32140966 DOI: 10.1007/s10029-020-02160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
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Comment on "Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study". Hernia 2020; 25:249. [PMID: 32140963 DOI: 10.1007/s10029-020-02151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
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