Association between preoperative acute phase response and postoperative complications.

OBJECTIVE: To find out if there is an association between the acute phase response preoperatively and the development of postoperative infective complications. DESIGN: Prospective open study. SETTING: Teaching hospital Germany. SUBJECTS: 229 patients who were to undergo major abdominal operations. INTERVENTIONS: Measurements of serum concentrations of interleukin 6 (IL-6), alpha-1-antitrypsin, C-reactive protein (CRP), albumin, and prealbumin. MAIN OUTCOME MEASURES: Abnormal values of substances measured. RESULTS: Serum concentrations of IL-6, alpha-1-antitrypsin and CRP were raised, and those of albumin and prealbumin were reduced in 5% to 14% of patients. 25 (11%) developed major complications, of whom 9 (4%) died. 9 Patients (4%) had a severe systemic inflammatory response caused by infective complications that did not result from technical failure of the operative technique. Of these 9 patients, 7 (78%) already had signs of an increased acute phase response before operation that was significantly different from the incidence among patients who recovered without complications (21/204. p < 0.001) CONCLUSION: These data suggest that if there are signs of an acute phase response preoperatively the patient's response to operation and infection during the postoperative period may be adversely affected.