C-reactive protein as an early marker of anastomotic leak after elective intestinal transit restoration surgery: a retrospective study in Hidalgo, Mexico

Abraham Romero Mendoza; José J. Guízar García; Amado R. Meneses Monroy; Erick M. Maldonado Ventura; Iván E. Bastidas Molina; Gerardo Lopez Leynez; Marian González Paulin; Carolina Meneses Hernández

doi:10.18203/2349-2902.isj20263837

Authors

Abraham Romero Mendoza Department of General Surgery, Tula General Hospital, Tula de Allende, Hidalgo, Mexico
José J. Guízar García Department of General Surgery, Tula General Hospital, Tula de Allende, Hidalgo, Mexico
Amado R. Meneses Monroy Department of General Surgery, Dra. Columba Rivera Osorio General Hospital, ISSSTE, Pachuca, Hidalgo, Mexico
Erick M. Maldonado Ventura Department of General Surgery, Tula General Hospital, Tula de Allende, Hidalgo, Mexico
Iván E. Bastidas Molina Department of General Surgery, Tula General Hospital, Tula de Allende, Hidalgo, Mexico
Gerardo Lopez Leynez Department of General Surgery, Tula General Hospital, Tula de Allende, Hidalgo, Mexico
Marian González Paulin Department of General Surgery, Dra. Columba Rivera Osorio General Hospital, ISSSTE, Pachuca, Hidalgo, Mexico
Carolina Meneses Hernández Department of General Surgery, Dra. Columba Rivera Osorio General Hospital, ISSSTE, Pachuca, Hidalgo, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20263837

Keywords:

Anastomotic leak, Biomarker, C-reactive protein, Colorectal surgery, Intestinal anastomosis, Postoperative complications

Abstract

Background: Anastomotic leak is one of the most serious complications of intestinal surgery, and its early diagnosis remains difficult in hospitals with limited access to imaging. This study evaluated whether a serum C-reactive protein (CRP) concentration above 135 mg/l on postoperative day 3 is associated with anastomotic leak after elective intestinal transit restoration surgery.

Methods: This observational, retrospective study reviewed the clinical and laboratory records of adults who underwent elective intestinal transit restoration at the Dra. Columba Rivera Osorio General Hospital, Pachuca, Hidalgo, Mexico, between January 2021 and January 2024. CRP on postoperative day 3 was dichotomised at 135 mg/L and cross-tabulated against anastomotic leak. Association was tested with the Chi-square test (α=0.05) and its strength with Cramér’s V.

Results: Of 50 records reviewed, 36 patients were included. Anastomotic leak occurred in 6 patients (16.7%) and CRP exceeded 135 mg/l in 10 (27.8%). All six patients with a leak had CRP above the cut-off, and no leak occurred among the 26 patients below it. The association was significant (χ²=18.72, p<0.001) and strong (Cramér’s V=0.72); sensitivity was 100%, specificity 86.7%, positive predictive value 60% and negative predictive value 100%. Type of anastomosis, anastomotic site and underlying diagnosis were not associated with leak.

Conclusions: A CRP above 135 mg/l on postoperative day 3 was strongly associated with anastomotic leak. As a low-cost, widely available test, CRP may serve as an early warning and rule-out tool in resource-limited hospitals, complementing clinical assessment and imaging. Larger prospective studies should validate this cut-off.

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