eP529 - The Rise of CRP: Does CRP Really Predict Anastomotic Leak in Patients Undergoing Colorectal Surgery?

ePoster Presenter(s)

• 

  Faris S. Almadi, MD

  Colorectal Surgery Research Fellow
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• MB

  Mikhael Belkovsky, MD

  Colorectal Surgery Research Fellow
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Anuradha R. Bhama, MD

  Staff Surgeon
  Department of Colorectal Surgery
  Cleveland Clinic
  Cleveland, OH, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• LD

  Leonardo C. Duraes, MD PhD

  Staff Surgeon
  Department of Colorectal Surgery
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Jeremy M. Lipman, MD, MHPE

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Tracy L. Hull, MD

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
  Chagrin Falls, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AK

  Arielle Kanters, MD, MS

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• HK

  Hermann Kessler, MD, PhD

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• OL

  Olga Lavryk, MD, PhD

  Clinical Associate
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• JS

  Joshua Sommovilla, MD

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Anna R. Spivak, DO (she/her/hers)

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic Foundation
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Michael A. Valente, DO

  Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• EG

  Emre Gorgun, MD, MBA

  Vice Chair, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Scott Steele, MD MBA

  President, Chairman, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  David Liska, MD

  Associate Professor of Surgery, Chair
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland Clinic, Cleveland, Ohio
  Cleveland, OH, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Stefan D. Holubar, MD, MS

  Director of Research, Staff Surgeon
  Department of Colorectal Surgery, Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Purpose/Background: The association between C-reactive protein (CRP) levels and anastomotic leak is a matter of controversy in the literature. Our study aimed to investigate the potential use of 7-day CRP measurements to predict anastomotic leak in all patients who underwent colorectal surgery.Methods/Interventions: We retrospectively reviewed our internal National Surgical Quality Improvement Program (NSQIP) data registry. All patients who underwent colorectal surgery involving an anastomosis for colorectal cancer, diverticular disease, Crohn’s disease, ulcerative colitis, or intermediate colitis between 2021-2023 were included. Emergency cases and patients who underwent surgery without anastomosis (i.e., end ileostomy or end colostomy) were excluded. CRP levels were measured on postoperative days one to seven (POD 1-7). We investigated the association between leak and: (a) daily CRP levels from day 1 to day 7; (b) the linear differences between POD3 and POD1 (early changes), and the linear difference between POD7 and POD4 (late changes); and (c) increases in CRP levels on consecutive days from POD 2 to POD7 (with cutoffs of 20, 50, 70, and 100 mg/L). We performed univariate logistic regression with receiver operating characteristic curves using “R” version 4.3.1.Results/Outcomes: A total of 1,494 patients were included. The mean age was 55 years, 47.1% were female, and the mean BMI was 28.1 kg/m2. The mean duration of surgery was 242 min. The median length of hospital stay was 4 days. The rate of leak was 1.6% (24 patients), and the median day of leak diagnosis was POD 8 (IQR 4.5-12). Nine leaks (37.5%) were diagnosed after initial discharge and required readmission. The following CRP values were associated with leak (Table 1): (a) absolute CRP values on POD 2-7 (all p < 0.05, AUC range = 0.60 – 0.79); (b) the early changes (p = 0.0012, AUC = 0.66); and (c) increases in consecutive days in 20, 30, 50, 70 and 100 mg/L (all p < 0.05, AUC range = 0.62-0.73). Overall, the best predictors of leak were CRP levels on POD5 (AUC = 0.78) and POD7 (AUC = 0.79) with respective cutoff values of 114 mg/L and 82 mg/L (PPV = 9.9% for both; NPV= 99.2% and 98.6%, respectively).Conclusion/

Discussion: CRP levels, specifically absolute values, deltas, and increases in consecutive days, were associated with anastomotic leak after elective colorectal resection. In our analysis, if a patient on POD 5 had a CRP >114 mg/L, the risk of a leak increased more than 6 times (from 1.6% to 9.9%), which may warrant early investigation, such as contrast imaging.Table 1Table 1. Association of CRP levels and anastomotic leak from multiple angles