Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study.

Pochhammer, J; Scholtes, B; Keuler, J; Müssle, B; Welsch, T; Schäffer, M

PURPOSE Infectious complications (ICs) after mesh-reinforced ventral hernioplasty often lead to prolonged and complicated hospitalizations. As early diagnosis and management can mitigate complications, early prediction is important. Our aim was to determine whether postoperative blood tests are valuable predictors of IC. METHODS We retrospectively analyzed 373 patients who underwent conventional ventral hernioplasty with mesh augmentation between 2008 and 2011. The clinical outcome was correlated with postoperative serum C-reactive protein (CRP) and white blood cell counts (WBC) and assessed by area under the curve (AUC) analysis of the receiver operating characteristics curve. RESULTS ICs occurred in 51 (13.7%) patients, who required further management. Among these, 48 patients developed a procedure-related complication, the most frequent being surgical site infection (n = 44). The infections appeared after a median postoperative delay of 12 days. Serum CRP was superior to WBC in the prediction of a complicated course. A maximum CRP < 105 mg/L on postoperative day (POD) 2 or 3 had the highest negative predictive value (NPV; 100%) in ruling out ICs [positive predictive value (PPV) 29%; sensitivity 100%; specificity 55%]. The PPV for occurrence of IC improved each day after surgery, reaching up to 46% on POD 5 or 6 for a CRP cut-off of 63.2 mg/L (NPV 93%; sensitivity 69%; specificity 83%). The AUC was 0.80 at both time points. CONCLUSIONS Our results indicate that postoperative serum CRP allows for early prediction of the postoperative course. Low CRP during the initial PODs is associated with lower risk of ICs. Higher levels on POD 5 or 6 behoove close surveillance.