Identificació Precoç de la Infecció Greu del Lloc Quirúrgic en Cirurgia Colo-Rectal Electiva Mitjançant els Marcadors Biològics Proteïna C-Reactiva i Lactat Venós.
To access the full text documents, please follow this link: http://hdl.handle.net/10803/362920
Author
Juvany Gómez, Montserrat
Other authors
Guirao Garriga, Xavier
Badia Pérez, Josep Maria
Universitat Internacional de Catalunya. Departament de Medicina
Date of defense
2016-03-10T09:58:46Z2016-03-10T09:58:46Z
2015-12-22
Abstract
Previous studies demonstrated that increased levels of C-reactive protein (CRP) after colo-rectal surgery are correlated to postoperative organ-space surgical site infection (OS-SSI) even at 48 hours time point. Such early inflammatory response might suggest that intraoperative haemodynamic factors might influence intestinal anastomosis healing.
Objective: To evaluate the correlation between early postoperative venous lactate, CRP at 48 hours and intraoperative haemodynamics and the incidence of OS-SSI in patients operated on elective colorectal surgery with anastomosis.
Materials and methods. From March 2013 to August 2014, all patients undergoing colorectal surgery with anastomosis were prospectively included. Levels of venous lactate were measured at the end of surgery (L-PO) and at 6 (L-6) and 24 hours afterwards (L-24). CRP levels at postoperative 48 hours (CRP-48) were also measured. We compared lactate levels and CRP values in patients with and without OS-SSI infection. Proportion of time that patients developed intraoperative systolic hypotension (SBP<100 mmHg) or tachycardia (>90 bpm) were also assessed. Data are summarized as mean ± SD. To analyze data, Student t-test and a logistic regression model with L-0 and CRP-48 with a ROC curve of this model were performed.
Results. One hundred patients were included, with an age of 69±11 years-old. Forty-four percent of patients were operated by laparoscopic approach. Eleven out of 100 patients (11%) complained OS-SSI. OS-SSI patients had significantly higher venous lactate levels at L-PO and at L-24 (3,2 vs 1,5, p<0,001 and 1,8 vs 1,2, p=0,0002, mmol/L, respectively). Overall, patients with L-PO >2,5 mmol/L had higher CRP-48 levels (140±85 vs. 78±57 mg/L, respectively, p=0,001). With the logistic regression model with L-PO and CRP-48 and ROC curve of this model: in patients with more than 0,26 of probability, OS-SSI should be discarded (AUC 0,899). Analysing haemodynamics behaviour, patients who developed OS-SSI remained hypotensive (50 % vs 30%, p=0,03) and tachycardic (18% vs 5%, p=0,02) for a longer period of time.
Conclusions. Early postoperative venous lactate and CRP at 48 hours correlated to OS-SSI appearance. Determination of biological markers and haemodynamics goal-oriented intraoperative management might improve the postoperative outcome.
Document Type
Thesis
Published version
Language
Catalan
Subjects and keywords
Lactat venós
Infecció òrgan-espai
Cirurgia colo-rectal
Cirugia Abdominal
61
Pages
158 p.
application/pdf
application/pdf
Publisher
Universitat Internacional de Catalunya
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Rights
L'accés als continguts d'aquesta tesi queda condicionat a l'acceptació de les condicions d'ús establertes per la següent llicència Creative Commons: http://creativecommons.org/licenses/by-nc-nd/3.0/es/