C-reactive protein values after surgery for inflammatory bowel disease: is it still a good marker for intra-abdominal complication? A retrospective cohort study of 347 procedures

Purpose C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible for chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study is to evaluate CRP as an indicator of postoperative complication in a specific IBD population. Methods Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between 2012 and 2019. Results Ileocolic resection represents 242 patients and ileal pouch-anal anastomosis 105 patients. CRP was significantly higher at an early (105.2 ± 56.0 vs 128.1 ± 69.8; p = 0.008) and late stage (112.9 ± 72.8 vs 185.3 ± 111.5; p < 0.0001) for patients having an intra-abdominal complication. A BMI > 25 kg/m 2 ( p = 0.04) and an open surgical approach ( p = 0.009) were associated with higher CRP levels in the first postoperative days (POD). In multivariate analysis, preoperative steroid use ( p = 0.06), CRP at POD 3 > 100 mg/L ( p = 0.003), and a rise between CRP values ( p = 0.007) at 48 h were significantly associated with intra-abdominal complication. A CRP at POD 1 < 75 mg/L was associated with a lower rate of intra-abdominal complication ( p = 0.01). A score dividing patients into 3 groups according to these values showed significant differences in intra-abdominal complication and anastomotic leakage rates. Conclusion CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.