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Diagnostic Value of C-Reactive Protein Levels in Postoperative Infectious Complications After Bariatric Surgery: a Systematic Review and Meta-Analysis

  • Lee, Yung1, 2
  • McKechnie, Tyler1, 2
  • Doumouras, Aristithes G.2, 3
  • Handler, Chovav3
  • Eskicioglu, Cagla2, 3
  • Gmora, Scott2, 3
  • Anvari, Mehran2, 3
  • Hong, Dennis2, 3
  • 1 McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada , Hamilton (Canada)
  • 2 McMaster University, Division of General Surgery, Department of Surgery, Hamilton, Ontario, Canada , Hamilton (Canada)
  • 3 McMaster University, Division of General Surgery, Department of Surgery, St. Joseph Healthcare, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada , Hamilton (Canada)
Published Article
Obesity Surgery
Publication Date
Mar 21, 2019
DOI: 10.1007/s11695-019-03832-5
Springer Nature


BackgroundBariatric surgery involves the risk of postoperative infectious complications, in particular, anastomotic leaks and intra-abdominal abscesses. C-reactive protein (CRP) is a nonspecific marker of inflammation which has gained attention as a test to predict postoperative infectious complications. This systematic review and meta-analysis evaluated the diagnostic value of CRP to detect postoperative infectious complications after bariatric surgery.MethodsSearch of MEDLINE, EMBASE, CENTRAL, and PubMed databases were performed. Articles measuring serum CRP postoperatively in patients with obesity undergoing bariatric surgery were included. Main outcomes included diagnostic value of postoperative serum CRP (area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)). Diagnostic accuracy of included studies was assessed using QUADAS-2.ResultsSix studies including 2770 patients met the inclusion criteria. The derived CRP cutoff values were 71.4 mg/dL, 130.3 mg/dL, and 118.7 mg/dL on postoperative days (PODs) 1, 3, and 5, respectively. Pooled AUC was similar across PODs 1, 3, and 5 with AUC being highest on POD 5 (0.88 ± 0.07). PPV was between 19 and 21%, and NPV was between 98 and 99%. CRP levels were significantly higher (P < .0001) in postoperative infectious complication group versus the no complication group on PODs 3 and 5.ConclusionsHigh NPV and moderately high sensitivity on PODs 1, 3, and 5 may help predict patients who are at a low risk of infectious complication following bariatric surgery. High specificity on PODs 1 and 3 also indicates that it can be useful for early diagnosis of postoperative infectious complications.

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