C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease

C Guyard; C de Ponthaud; A Frontali; M Monsinjon; M Giacca; Y Panis

doi:10.1007/s10151-022-02590-4

C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease

Tech Coloproctol. 2022 Jun;26(6):443-451. doi: 10.1007/s10151-022-02590-4. Epub 2022 Mar 3.

Authors

C Guyard¹, C de Ponthaud¹, A Frontali¹, M Monsinjon¹, M Giacca¹, Y Panis²

Affiliations

¹ Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France.
² Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France. yves.panis@aphp.fr.

PMID: 35239097
DOI: 10.1007/s10151-022-02590-4

Abstract

Background: The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC).

Methods: Four hundred and ten patients who underwent laparoscopic ICR for CD: 153 patients (CRP group) between June 2016 and June 2020 at our department, had a CRP-driven monitoring discharge on postoperative day (POD) 3 and were discharged on POD 4 if CRP < 100 mg/L. These patients were matched (according to age, sex, body mass index, type of CD (and stoma or not) to 257 patients who underwent laparoscopic ICR for CD between January 2009 and May 2016, without CRP monitoring (Control group). For SC, 79 patients with CRP monitoring were matched with 88 control patients. Primary outcome was overall length of hospital stay (LHS). Secondary outcomes were discharge on POD 4 for SC and POD 4 and POD 6 for ICR, 3-month postoperative overall morbidity and severe morbidity rates, surgical site infection, readmission rates, and CRP level in cases of morbidity at 3 months.

Results: For ICR without stoma, mean LHS was significantly shorter in the CRP group than in the control group (6.9 ± 2 days vs 8.3 ± 6 days, p = 0.017). Discharge occurred on POD 6 (or before) in 73% of the patients (CRP group) vs 60% (Control group) (p = 0.027). For ICR with stoma, LHS was 8 days for both groups (p = 0.612). For SC, LHS was significantly shorter in the CRP group than in the control group (5.5 ± 3 days vs 7.1 ± 4 days; p = 0.002). Discharge occurred on POD 4 in 62% (CRP group) vs 30% (Control) (p = 0.003). Postoperative 3-month overall and severe morbidity, and rehospitalization rates were similar between groups.

Conclusions: CRP-driven monitoring discharge strategy after laparoscopic ICR for CD is associated with a significant reduction of LHS, without increasing morbidity, reoperation or rehospitalisation rates.

Keywords: CRP monitoring; Crohn’s disease; Discharge strategy; Length of hospital stay; Resection ileocecal; Stoma closure.

MeSH terms

C-Reactive Protein / analysis
Cecum / surgery
Crohn Disease* / surgery
Humans
Laparoscopy* / adverse effects
Length of Stay
Postoperative Complications / etiology
Postoperative Complications / surgery

Substances

C-Reactive Protein