C‐reactive protein as a marker of the systemic inflammatory response to surgery reduction within an enhanced recovery after surgery protocol in elective colorectal surgery of the elderly: A prospective cohort study

Abstract

Aim The main aim of the present study was to evaluate the systemic inflammatory response (SIR) to surgery using C‐reactive protein (CRP) in patients <70 and ≥70 years of age, operated on by elective colorectal surgery with an enhanced recovery after surgery (ERAS) protocol, and to compare them with a historical cohort with standard care (pre‐ERAS group). The secondary objectives were to analyse the length of stay (LOS) in hospital, 30‐day readmission rates and complications in both age groups. Patients and Methods There was a total of 133 patients <70 years (69 in the pre‐ERAS group and 64 in the ERAS group) and 123 patients ≥70 years (66 in the pre‐ERAS group and 57 in the ERAS group). We compared the CRP values on postoperative days (POD) 1, 2 and 3 between the pre‐ERAS/ERAS group, laparoscopic/open surgery and the presence/absence of Clavien–Dindo complications. Multivariable linear regression was used to assess whether ERAS had a decreasing effect on the SIR on POD 1, 2 and 3. Results The groups were well balanced. The ERAS protocol decreased the SIR to surgery in patients ≥70 years. This could explain our good results, where there was a decrease in LOS in hospital in that group without an increase in 30‐day readmission rates or perioperative complications. ERAS protocol did not decrease the SIR at any point in the evolution of patients <70 years. The application of an ERAS protocol in patients≥70 years, laparoscopic surgery and not having complications reduced the SIR. Conclusion ERAS could be implemented without reservations in elderly patients undergoing elective colorectal surgeries and decreases the SIR to surgery and LOS in hospital more for younger patients than elderly patients.

A Systematic Review and Meta-Analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers

“…Screening of full-text articles identified a total of 45 studies that met eligibility criteria. 17–61 Search results and study selection are summarized in Figure 1.…”

“…Nine (8 noncardiac and 1 cardiac) reported an association between biomarker levels and our secondary outcomes of mortality and surgical or medical complications. 17,19,25,26,29,33,46,56,57 A formal meta-analysis of secondary outcomes was not possible as few studies reported these relationships and due to heterogeneity in outcome reporting. However, a narrative summary of the relationships between biomarkers and secondary outcomes investigated by each study is reported in Supplemental Digital Content 1, Appendixes 16–19, http://links.lww.com/AA/D747.…”