Krpata David M, Keller Deborah S, Samia Hoda, Lawrence Justin, Obokhare Izi, Marderstein Eric, Brady Karen M, Delaney Conor P
Pol Przegl Chir. 2013 Apr;85(4):198-203. doi: 10.2478/pjs-2013-0030.
Hospital length of stay (LOS) and readmissions continue to be expensive and unexpected events following colorectal surgery (CRS) whether patients follow enhanced recovery pathways or traditional care. Predictors of these adverse events could facilitate identification and optimization of CRS patients.
To examine the impact of white blood cell count (WBC) and C-reactive protein (CRP) levels as predictors of delayed recovery or hospital readmission following CRS.
Patients undergoing laparoscopic or open abdominal colorectal surgery by a single surgeon were managed using standardized enhanced recovery pathways. Those with postoperative day 2 CRP and white blood cell values were evaluated. Outcomes included 30-day hospital readmission rates and postoperative length of hospital stay.
CRP values were available for 193 patients (86 Male, mean age 58.6 years). Ninety-nine patients had surgery for colon cancer, 23 for Crohn's disease, 19 for ulcerative colitis, 31 for diverticulitis and 18 for other reasons. Twenty patients (10.4%) were readmitted to the hospital within 30 days of surgery. POD2 CRP accurately predicted short length of hospital stay (p< 0.01). Average CRP was 6.3 in the LOS of < 3 days or less, and 11.7 in patients with LOS >4 days. The mean CRP of the readmission and non-readmission groups was 11.8 and 9.9, respectively (p=0.29). The average POD 2 WBC of the readmission and non-readmission groups was 10.6 and 9 respectively (p=0.01).
A low POD2 CRP level was correlated with a shorter LOS, but it did not predict readmission. Conversely, POD2 WBC, and the difference in WBC from baseline were associated with readmission. These markers may be useful indicators to predict suitability of early discharge in an ERP. Further evaluation in prospective trials is warranted.
无论患者遵循强化康复路径还是传统护理，住院时间（LOS）和再入院仍然是结直肠手术（CRS）后昂贵且意外的事件。这些不良事件的预测因素有助于识别和优化CRS患者。
研究白细胞计数（WBC）和C反应蛋白（CRP）水平作为CRS后恢复延迟或再次入院预测指标的影响。
由单一外科医生进行腹腔镜或开腹结直肠手术的患者采用标准化强化康复路径进行管理。对术后第2天的CRP和白细胞值进行评估。结果包括30天再入院率和术后住院时间。
193例患者（86例男性，平均年龄58.6岁）有CRP值。99例患者因结肠癌手术，23例因克罗恩病手术，19例因溃疡性结肠炎手术，31例因憩室炎手术，18例因其他原因手术。20例患者（10.4%）在术后30天内再次入院。术后第2天CRP准确预测了住院时间短（p<0.01）。住院时间<3天或更短的患者平均CRP为6.3，住院时间>4天的患者平均CRP为11.7。再入院组和未再入院组的平均CRP分别为11.8和9.9（p=0.29）。再入院组和未再入院组术后第2天的平均白细胞分别为10.6和9（p=0.01）。
术后第2天CRP水平低与住院时间短相关，但不能预测再入院。相反，术后第2天白细胞以及白细胞与基线的差值与再入院相关。这些指标可能是预测在强化康复路径中早期出院适宜性的有用指标。有必要在前瞻性试验中进行进一步评估。
