Departments of Visceral and Thoracic Surgery.
Internal Medicine I, University Hospital Schleswig-Holstein, Kiel Campus, Christian-Albrechts-University of Kiel, Kiel, Germany.
Surg Laparosc Endosc Percutan Tech. 2020 Jun;30(3):238-244. doi: 10.1097/SLE.0000000000000767.
Bariatric surgery is popularly used to treat or prevent morbidity in severely obese patients. Severe complications are rare, but their early detection has a significant impact on clinical outcomes. We aimed to determine whether blood tests in the first few postoperative days are reliable predictors for complications.
We retrospectively analyzed 1073 patients who underwent laparoscopic bariatric surgery between 2009 and 2018 at our center. Clinical outcome was correlated with postoperative serum C-reactive protein (CRP), white blood cell count, and vital signs, analyzed using a receiver operating characteristic (ROC) curve. A total of 570 procedures between 2009 and 2015 were used to calculate the best cutoff values (calculation group), which were validated with 330 different patients operated upon between 2016 and 2018 (validation group).
Twenty-four patients (4.2%) developed anastomotic or staple-line leakages in the calculation group. The ROC curve showed a good reliability for CRP levels on day 2 (area under the ROC curve=0.86); the highest Youden index existed for a cutoff of 119 mg/L. White blood cell count and heart rate were poor predictors. Even though several characteristics differed in the validation cohort, test quality of the cutoff was high (sensitivity, 71.4%; specificity, 94.9%; positive predictive value, 23.8%; negative predictive value, 99.3%). The prediction was excellent especially for leakages appearing on days 2 to 9 (sensitivity 100.0%, negative predictive value 100%). Leakages from day 10 were rare and prediction poor (sensitivity 0%).
A CRP level on day 2 <120 mg/L is a good predictor of a postoperative course without leakage, even though the predictive value goes down for late-appearing events. An earlier CRP measurement added no predictive benefit. The cutoff value was validated in an internal cohort and could be applied to different populations.
减重手术常用于治疗或预防重度肥胖患者的发病率。严重并发症很少见，但早期发现对临床结果有重大影响。我们旨在确定术后几天的血液检查是否是并发症的可靠预测指标。
我们回顾性分析了 2009 年至 2018 年在我们中心接受腹腔镜减重手术的 1073 例患者。使用受试者工作特征（ROC）曲线分析术后血清 C 反应蛋白（CRP）、白细胞计数和生命体征与临床结果的相关性。使用 2009 年至 2015 年的 570 例手术计算最佳截断值（计算组），并用 2016 年至 2018 年的 330 例不同手术进行验证（验证组）。
计算组中有 24 例（4.2%）发生吻合口或钉线渗漏。ROC 曲线显示第 2 天 CRP 水平具有良好的可靠性（ROC 曲线下面积=0.86）；截断值为 119mg/L 时存在最高 Youden 指数。白细胞计数和心率是较差的预测指标。尽管验证组的一些特征不同，但该截断值的检测质量较高（灵敏度 71.4%，特异性 94.9%，阳性预测值 23.8%，阴性预测值 99.3%）。预测对于第 2 至 9 天出现的渗漏尤其出色（灵敏度 100.0%，阴性预测值 100%）。第 10 天以后出现的渗漏很少，预测效果较差（灵敏度 0%）。
术后第 2 天 CRP 水平<120mg/L 是术后无渗漏的良好预测指标，尽管对于晚期出现的事件，预测值会降低。更早的 CRP 测量并没有增加预测的好处。该截断值在内部队列中得到验证，可应用于不同人群。
