C-reactive protein measurement is not associated with an improved management of acute cholecystitis: a plié for a change

Abstract

BackgroundThe diagnosis of acute cholecystitis (AC) is challenging and may result in a delay in surgical treatment and increased mortality. The 2007 and 2013 Tokyo Guidelines for AC proposed to use C-reactive protein (CRP) as an additional bench mark of AC. The aim of this study was to evaluate whether CRP measurement influences management of patients with AC. MethodsFor more than a period of 5 y (May 2004 to June 2009), 1959 patients were identified from the audit of cholecystectomies in North Shore, Waitakere and Southern Cross hospitals at Waitemata District Health Board, Auckland, New Zealand. The exclusion criteria were elective and private patients, patients without AC on histologic examination of gallbladders, and patients with acute acalculous cholecystitis. ResultsA total of 414 patients met eligibility criteria. Compared with the non-CRP group, patients who had CRP measured had a longer time to operation theater and a greater proportion of acute gangrenous cholecystitis on histologic examination of excised gallbladders, but similar postoperative complication rate, index, and total hospital stay. Time to operation theater was not associated with development of acute gangrenous cholecystitis (odds ratio, 1.0; 95% confidence interval, 0.996–1.01; P = 0.797), but correlated with the index hospital admission length (correlation coefficient, 0.6092; P < 0.001). ConclusionsCRP measurement does not influence management of patients with AC. To improve quality of care and to minimize health care provider costs physiologically fit patients with more advanced forms of AC and higher values of CRP should have their operation performed earlier than patients with mild AC and a lower concentration of CRP.