CLINICAL AND INFLAMMATORY RESPONSE MARKERS, PREDICTORS OF SAFETY AT DISCHARGE IN POSTOPERATIVE COLORECTAL SURGERY PATIENTS
QUINTIN GONZALEZ*1, BELEN LARUMBE2, MONICA DE JESUS2, JESUS A. BAHENA-APONTE2, JUAN JOSE NUÑEZ2, JOSE M MORENO2
1CIRUGIA, Medica Sur, Ciudad de Mexico, Distrito Federal, Mexico; 2HMG HOSPITAL COYOACAN, MEXICO CITY, Mexico
Colorectal surgery can have complications of great postoperative impact that lead to increased morbidity and mortality, hospital stay and frequently require surgical reintervention. Its incidence is highly variable and ranges from 1-40% worldwide, making it a challenge for the surgeon to avoid associated morbimortality.
A prospective study was performed with a sample of 22 patients with different colorectal diseases managed with hemicolectomy, analyzing serological markers of inflammation and clinical criteria as predictors of good prognosis at patient discharge.
MATERIAL AND METHODS:
From March 2021 to October 2022 a total of 22 patients were included in a prospective study in three private hospitals in Mexico City, during the postoperative period of their hemicolectomy, 53.33% were men and 46.66% women, complicated diverticular disease was the most operated pathology 80% and 20% had colorectal cancer. A total of 93.34% of the patients were operated with laparoscopic approach and primary colorectal anastomosis, 6.66% with open technique and protective stoma. Patients were evaluated daily after surgery, obtaining on days 0, 3 and 5 serological markers such as leukocytes, absolute neutrophils, platelets, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin, which were associated with clinical signs including heart rate, temperature, respiratory rate and blood pressure.
According to the literature, the cut-off value for CRP is <150mg, for procalcitonin the cut-off range is 1.3-2mg. The safety ranges we stipulated according to the samples obtained were Procalcitonin <2mg/dl at 0, 3rd and 5th day. CRP with ranges of <300, <150 and <100 mg/dl respectively, for ESR we established ranges of <100 at day 0 and <50 mm/h at day 3 and 5. As for leukocytes with parameters <15 at day 0 and 3 and <11 x10*/L at day 5. (Tables and graphs 1-4)
Clinical data found had similar values on day one and three, varying on the 5th day: BP <140/90 1st and 3rd day, <130/90mmHg on the fifth; HR days one and three <120, day five <100 bpm; FR <20, day one and three and <18 rpm fifth day; temperature <38.5 and <37.5 C respectively.
The results were correlated with clinical evolution, observing that by remaining within the stipulated ranges, we obtained a median hospital stay of 3 days, early discharge, satisfactory postoperative evolution and no associated complications.
This study demonstrates the existence of a standardized method that can be carried out practically, safely and without generating high expenses to the patients or the hospital to give an adequate follow-up to the postoperative evolution of patients with colorectal surgery, acting opportunely before the alteration of these markers due to the possibility of complications.
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