C-reactive Protein for Predicting Early Postoperative Complications in Patients Undergoing Laparoscopic Shaving for Deep Infiltrating Endometriosis

Diego Raimondo, Raffone A, Antonio Raffone, Anna Chiara Aru, Paolo Salucci, Salucci P, Antonio Travaglino, Maletta M, Manuela Maletta, Ambrosio M, Marco Ambrosio, Borghese G, Giulia Borghese, Raffaella Iodice, Iodice R, Paolo Casadio, Renato Seracchioli
Journal of Minimally Invasive Gynecology · 2021 · vol. 29(1) , pp. 135–143 · doi:10.1016/j.jmig.2021.07.009 · PMID:34280565 · W3184092909
article OA: closed CC0 ⤵ 2 in-corpus citations
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This study investigated C-reactive protein's ability to predict early postoperative complications following laparoscopic shaving for deep infiltrating endometriosis.

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Abstract

Study objectiveTo 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).DesignA single-center observational retrospective cohort study.SettingThird-level referral center for endometriosis.PatientsA total of 294 patients were included in the study. All of them underwent elective laparoscopic shaving for rectosigmoid DIE.InterventionsPostoperative CRP levels (assessed from day 3 onward, every 48 hours, until hospital discharge) and early postoperative complications were reviewed to assess CRP as a predictive marker of postoperative complications.Measurements and main resultsThe study outcomes were the association between early postoperative complications and CRP levels, the optimal CRP cutoff, 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 levels between patients with and without complications was 2.5 mg/dL (95% CI, 1.0-4.1), whereas on day 5 the difference was 5.3 mg/dL (95% CI, 3.3-7.5), with a significant increase of 2.8 mg/dL (95% CI, 0.2-5.5). On postoperative day 7 the difference was 11.4 mg/dL (95% CI, 8.2-14.6), with an increase of 6.1 mg/dL (95% CI, 2.2-9.9) from day 5. The mean CRP level in the group with complications showed an increase of 1.2 mg/dL (95% CI, -1.3 to 3.8) from day 3 to day 5 and of 6.2 mg/dL (95% CI, 2.6-9.8) from day 5 to day 7. The optimal cutoff for the CRP level 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% (95% CI, 52.9-97.8) and 80% (95% CI, 37.6-96.4), a specificity of 62.5% (95% CI, 52.1-71.9) and 91.2% (95% CI, 81.1-96.2), a positive predictive value of 17.5% (95% CI, 8.7-31.9) and 44.4% (95% CI, 18.9-73.3), a negative predictive value of 98.2% (95% CI, 90.6-99.7) and 98.1% (95% CI, 90.1-99.7), and an area under the receiver operating characteristic curve of 75.0% (95% CI, 61.9-80.1) and 85.6% (95% CI, 74.1-96.5), respectively.ConclusionCRP on postoperative day 5 seemed to be a moderately accurate predictive marker of early postoperative complications in the patients who had undergone elective laparoscopic shaving for rectosigmoid DIE.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Laparoscopy Cohort Studies C-Reactive Protein C-Reactive Protein Female Humans Postoperative Complications Postoperative Complications Postoperative Complications Retrospective Studies

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