Hospital stay for temporary stoma closure is shortened by C-reactive protein monitoring: a prospective case-matched study.
Dosage-driven-strategy
Length of hospital stay
Postoperative CRP monitoring
Stoma closure
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
11
01
2019
accepted:
13
05
2019
pubmed:
28
5
2019
medline:
21
1
2020
entrez:
27
5
2019
Statut:
ppublish
Résumé
C-reactive protein (CRP) has been suggested as a satisfactory early marker of postoperative complications after colorectal surgery. The aim of this study was to assess the impact of a CRP monitoring-driven discharge strategy, after stoma reversal following laparoscopic sphincter-saving surgery for rectal cancer. Eighty-eight patients who had stoma reversal between June 2016 and April 2018 had CRP serum level monitoring on postoperative day (POD) 3 and, if necessary, on POD5. Patients were discharged on POD4 if the CRP level was < 100 mg/L. Patients were matched [according to age, gender, body mass index, neoadjuvant pelvic irradiation, type of anastomosis (stapled or manual), and adjuvant chemotherapy] to 109 identical control patients who had stoma reversal between 2012 and 2016 with the same postoperative care but without CRP monitoring. Postoperative 30-day overall morbidity [CRP group: 12/88 (14%) vs controls: 11/109, (10%), p = 0.441] and severe morbidity rates (i.e. Dindo 3-4) [CRP group: 2/88 (2%) vs controls: 2/109 (2%), p = 0.838] were similar between groups. Mean length of stay was significantly shorter in the CRP group (CRP group: 4.6 ± 1.3 vs controls: 5.8 ± 1.8 days; p < 0.001). Discharge occurred before POD5 in 59/88 (67%) CRP patients vs 15/109 (14%) controls (p < 0.001). The unplanned rehospitalization rate [CRP group: 6/88 (7%) vs controls: 4/109 (4%), p = 0.347] was similar between groups. In patients having temporary stoma closure after laparoscopic surgery for rectal cancer, postoperative CRP monitoring is associated with a significant shortening of hospital stay without increasing morbidity or rehospitalization rates.
Sections du résumé
BACKGROUND
BACKGROUND
C-reactive protein (CRP) has been suggested as a satisfactory early marker of postoperative complications after colorectal surgery. The aim of this study was to assess the impact of a CRP monitoring-driven discharge strategy, after stoma reversal following laparoscopic sphincter-saving surgery for rectal cancer.
METHODS
METHODS
Eighty-eight patients who had stoma reversal between June 2016 and April 2018 had CRP serum level monitoring on postoperative day (POD) 3 and, if necessary, on POD5. Patients were discharged on POD4 if the CRP level was < 100 mg/L. Patients were matched [according to age, gender, body mass index, neoadjuvant pelvic irradiation, type of anastomosis (stapled or manual), and adjuvant chemotherapy] to 109 identical control patients who had stoma reversal between 2012 and 2016 with the same postoperative care but without CRP monitoring.
RESULTS
RESULTS
Postoperative 30-day overall morbidity [CRP group: 12/88 (14%) vs controls: 11/109, (10%), p = 0.441] and severe morbidity rates (i.e. Dindo 3-4) [CRP group: 2/88 (2%) vs controls: 2/109 (2%), p = 0.838] were similar between groups. Mean length of stay was significantly shorter in the CRP group (CRP group: 4.6 ± 1.3 vs controls: 5.8 ± 1.8 days; p < 0.001). Discharge occurred before POD5 in 59/88 (67%) CRP patients vs 15/109 (14%) controls (p < 0.001). The unplanned rehospitalization rate [CRP group: 6/88 (7%) vs controls: 4/109 (4%), p = 0.347] was similar between groups.
CONCLUSIONS
CONCLUSIONS
In patients having temporary stoma closure after laparoscopic surgery for rectal cancer, postoperative CRP monitoring is associated with a significant shortening of hospital stay without increasing morbidity or rehospitalization rates.
Identifiants
pubmed: 31129752
doi: 10.1007/s10151-019-02003-z
pii: 10.1007/s10151-019-02003-z
doi:
Substances chimiques
Biomarkers
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
453-459Références
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Br J Surg. 2005 Feb;92(2):211-6
pubmed: 15584062
Ann Surg. 2005 Jan;241(1):9-13
pubmed: 15621985
Arch Surg. 2005 Mar;140(3):278-83, discussion 284
pubmed: 15781793
Br J Surg. 2006 Apr;93(4):498-503
pubmed: 16491473
Lancet Oncol. 2007 Apr;8(4):297-303
pubmed: 17395102
Ann Surg. 2007 Aug;246(2):207-14
pubmed: 17667498
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Ann Surg. 2008 Jul;248(1):52-60
pubmed: 18580207
Int J Colorectal Dis. 2009 Jun;24(6):711-23
pubmed: 19221766
J Gastrointest Surg. 2009 Sep;13(9):1599-606
pubmed: 19479312
Colorectal Dis. 2011 Jun;13(6):632-7
pubmed: 20236150
Ann Surg. 2012 Aug;256(2):245-50
pubmed: 22735714
Ann Surg Oncol. 2012 Dec;19(13):4168-77
pubmed: 22805866
Dis Colon Rectum. 2013 Apr;56(4):475-83
pubmed: 23478615
Tech Coloproctol. 2013 Oct;17(5):541-7
pubmed: 23619713
Colorectal Dis. 2013 Sep;15(9):e528-33
pubmed: 24199233
Br J Surg. 2014 Mar;101(4):339-46
pubmed: 24311257
Colorectal Dis. 2015 Sep;17(9):820-3
pubmed: 25808587
PLoS One. 2015 Jul 15;10(7):e0132995
pubmed: 26177542
Br J Surg. 2017 Feb;104(3):288-295
pubmed: 27762432
Colorectal Dis. 2017 Feb;19(2):115-122
pubmed: 27801543
Surgery. 2017 Apr;161(4):1028-1039
pubmed: 27894710
Br J Surg. 2017 Apr;104(5):503-512
pubmed: 28295255
Int J Colorectal Dis. 2017 Dec;32(12):1771-1774
pubmed: 28918433
Surg Endosc. 2018 Sep;32(9):4003-4010
pubmed: 29520440
J Cell Biol. 1986 Sep;103(3):787-93
pubmed: 3017995
Ann Fr Anesth Reanim. 1994;13(5 Suppl):S145-53
pubmed: 7778802