Williams Murray R, McMeekin Samuel, Wilson R Jonathan T, Miller Glenn V, Langlands Fiona E, Wong Wingzou, Peter Mark, Giles Mathew S
Department of Surgery, York Teaching Hospitals NHS Trust, York, UK.
Department of Anaesthetics, York Teaching Hospitals NHS Trust, York, UK.
Obes Surg. 2017 Mar;27(3):709-715. doi: 10.1007/s11695-016-2349-z.
Laparoscopic roux-en-Y gastric bypass (LRYGB) has gained increasing popularity as the primary procedure of choice for the management of patients with morbid obesity. Despite the advances, a few patients will still develop complications and predicting these early complications in morbidly obese patients can prove to be difficult. Radiological investigations have limited diagnostic value and have associated side effects and cost. We propose that C-reactive protein (CRP) is a useful predictor for early postoperative complications. This study aims to determine the ability of CRP taken on postoperative day 1 (POD 1) and 2 to predict occurrence of complications within 30 days of surgery.
This retrospective observational study selected 183 consecutive patients from the York bariatric database between 01 December 2010 and 23 March 2015.
Patients undergoing dual procedures, conversion to open, and if no postoperative CRP measurement was performed.
In total, 138 patients satisfied the inclusion criteria during the study period (median age 44 years [20-68], BMI 50.6 kg/m2 [38.3-62.5]). Fifteen (10.8 %) patients had minor complications (CD of 2) and 8 (5.6 %) had major complications (CD 3 or above). A CRP of greater than 127 mg/L on POD 2 was found to predict complications with 93 % sensitivity and 64 % specificity with diagnostic accuracy 0.82 (95 % confidence interval 0.731-0.908).
In our patients, CRP on POD 2 has been shown to be a good predictor of both minor and major complications and can therefore be used to guide clinicians in making decision as to which patients may need further investigation or who can be safely discharged.
腹腔镜Roux-en-Y胃旁路术（LRYGB）作为治疗病态肥胖患者的主要首选术式越来越受欢迎。尽管取得了进展，但仍有少数患者会出现并发症，而预测病态肥胖患者的这些早期并发症可能很困难。放射学检查诊断价值有限，且有相关副作用和费用。我们认为C反应蛋白（CRP）是术后早期并发症的有用预测指标。本研究旨在确定术后第1天（POD 1）和第2天测定的CRP预测手术30天内并发症发生的能力。
这项回顾性观察研究从2010年12月1日至2015年3月23日的约克肥胖症数据库中选取了183例连续患者。
接受联合手术、转为开放手术的患者，以及未进行术后CRP测量的患者。
在研究期间，共有138例患者符合纳入标准（中位年龄44岁[20 - 68岁]，BMI 50.6 kg/m²[38.3 - 62.5]）。15例（10.8%）患者出现轻微并发症（Clavien-Dindo分级2级），8例（5.6%）出现严重并发症（Clavien-Dindo分级3级或以上）。发现术后第2天CRP大于127 mg/L预测并发症的敏感性为93%，特异性为64%，诊断准确性为0.82（95%置信区间0.731 - 0.908）。
在我们的患者中，术后第2天的CRP已被证明是轻微和严重并发症的良好预测指标，因此可用于指导临床医生决定哪些患者可能需要进一步检查或哪些患者可以安全出院。
