Piotr Major, MD, PhD1, Michal Wysocki, MD1, Tomasz Stefura1, Jakub Dros1, Artur Kacprzyk1, Katarzyna Chlopas1, Katarzyna Major2, Piotr Malczak1, Magdalena Pisarska1, Michal Pedziwiatr1, Andrzej Budzynski, Professor1. 12nd Department of General Surgery, Jagiellonian University Medical College, 2Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Introduction: We aimed to determine if there are correlations between of C-reactive protein, procalcitonin and white blood count measured in first, second and third postoperative day after bariatric surgeries and postoperative morbidity (1-month and 12-months), length of hospital stay (LOS) and hospital readmissions.
Methods and Procedures: Retrospective cohort study of patients who underwent laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (GB) or mini-gastric bypass (MGB) for morbid obesity in seven referral bariatric centers. Patients were divided into two groups: complicated group – patients with postoperative complications (in 1 month or 12 months postoperative period) and non-complicated group – patients without postoperative morbidity. Primary endpoint: to determine utility of routinely tested inflammatory markers in prognosis of perioperative (30-days) and postoperative (12-months excluding first 30-days) morbidity rates. Secondary endpoints: utility of inflammatory markers to determine risk of LOS after bariatric surgeries and readmissions.
Results: 2125 patients, 1448 females (68%) and 677 males (32%) in median age of 43 (35-52) years were included. Postoperative morbidity was 155 patients (7.29%), of who 112 cases occurred in first postoperative month and 43 cases after first postoperative month during 12-months follow-up. Sex, age, BMI and co-morbidities did not differ complicated and non-complicated cases. In complicated group LOS was significantly longer as well as readmission rate. CRP (OR: 1.02, 95%CI: 1.01-1.03), WBC (1.23, 1.15-1.32), PCT (17.18, 3.09-95.46) on POD1 used as continuous variables were significantly increasing OR for perioperative morbidity. ROC analysis indicated suggested cut-off point of CRP on POD1 indicating for risk of perioperative morbidity for 23.8 mg/L, WBC for 10×103/mm3, and PCT for 0.22 ng/mL. In case of postoperative morbidity inflammatory parameters on POD1 were not significantly related to ORs (p-values respectively: 0.713, 0.189, 0.889). CRP (OR: 1.02, 95%CI: 1.01-1.03), WBC (1.10, 1.02-1.20), PCT (4.7, 1.12-19.64) were increasing OR for prolonged LOS. ROC analysis indicated suggested cut-off point of CRP on POD1 indicating for risk of prolonged LOS for 35 mg/L, WBC for 8.9×103/mm3, PCT for 0.05 ng/mL. CRP (OR: 1.01, 95%CI: 1.00-1.03), WBC (1.21, 1.09-1.33) on POD1 were significantly increasing OR for readmissions, while PCT was not (6.67, 0.97-45.80). ROC analysis indicated suggested cut-off point of CRP on POD1 indicating for risk of readmissions for 94 mg/L, WBC for 14.5×103/mm3.
Conclusion: Even moderate increase in inflammatory parameters on POD1 should alert surgeon for possibility of increased chance for perioperative morbidity, prolonged LOS and hospital readmissions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94552
Program Number: P088
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster