ArticleTechniques in coloproctology2026
Safe discharge on the second postoperative day after major colorectal surgery: a decision-making strategy based on quantitative serological data.
Article in Techniques in coloproctology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEnhanced Recovery After Surgery (ERAS) has enabled early patient discharge, but reliable biomarkers are needed to support safe early discharges. C-reactive protein levels have been reported as good markers for early anastomotic leak detection and also for overall complications, but there is no consensus yet on its quantification nor day of analysis.
objectiveThis study aimed to determine the C-reactive protein cutoff values at postoperative day (POD) 2-4 associated with the lowest risk of postoperative complications.
designSingle-center, retrospective study. SETTINGS: Tertiary hospital. PATIENTS: Patients operated on between 2019 and 2022.
interventionsSurgery for colorectal cancer.
main outcome measuresC-reactive protein on postoperative days 2-4 and the delta difference between postoperative days 3 and 2 were measured, identifying the best cutoff value for each postoperative complication. Receiver-operating characteristics curves were generated and the area under the curve was analyzed for each postoperative day measurement.
resultsA total of 434 patients were included, median age was 72 (62-80) years. On postoperative day-2, the cutoff values for overall morbidity, surgical complications, medical complications, and anastomotic leak were 139.2 mg/L, 144.4 mg/L, 140 mg/L, and 170 mg/L, respectively. POD3 and 2 were both safe (area under the curve of 0.7507 and 0.7466, respectively). The negative predictive values using a C-reactive protein POD2 cutoff value of 140 mg/L were 80.6%, 91.5%, 87.6%, and 98.6% for global, medical, surgical complications, and anastomotic leak, respectively. LIMITATIONS: Retrospective study.
conclusionsCarefully selected, motivated, and clinically suitable patients could be offered discharge on POD2 if their C-reactive protein levels are below 140 mg/L, with a very high negative predictive value for anastomotic leak and other postoperative complications. This decision should be made in collaboration with patients, considering clinical assessment and logistic factors.
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