Post-operative C-reactive protein profile following abdominal wall reconstruction with transversus abdominis posterior components separation

IntroductionAbdominal wall reconstruction using posterior component separation with transversus abdominis release (AWTAR) produces a unique post-operative CRP profile, when compared to routine elective colorectal operations. Therefore, we aim to establish the normal post-operative C-reactive protein (poCRP) profile following AWRTAR and reduce the unnecessary invasive interventions in patients already at greater risk of septic complications.MethodsA retrospective analysis of daily poCRP levels was performed both for patients who underwent uncomplicated AWRTAR (n = 12), and a comparator group of uncomplicated open right hemicolectomies (RH) matched for age and sex (n = 24). All operations in both groups were performed by a single surgeon from 2013 to 2015.ResultsThe median (IQR) age was 62 (16) and 67 (16) years respectively, with a higher proportion of males to females in both groups (10:2 vs. 17:7). The poCRP profile follows an initial steep rise, peaking at day 2 followed by a gradual washout phase. The poCRP peak is significantly greater in the AWRTAR group compared to the RH group (274 95%CI ±25] vs. 160 95%CI ± 27]; p = 0.0001), with a positive correlation between day 2 CRP levels and operative length (r = 0.56).ConclusionsWe have demonstrated that uncomplicated AWRTAR provokes a significantly greater poCRP rise (>200) compared to that well described in the literature for uncomplicated open colectomy. As poCRP is an important marker of post-operative recovery with abnormally high levels associated with septic complications, these data should help clinicians interpret the post-operative clinical course after AWRTAR.