C-reactive Protein of Blood Plasma as a Precursor of Early Surgical Complications in Prosthetic Repair of the Anterior Abdominal Wall

Introduction. Despite the achievements in the treatment of abdominal hernias, the incidence of postoperative complications is still high, which entails an increased probability of hernia recurrence, repeated surgical interventions, and an increased mortality rate. Detection of the precursors of the above complications will allow for their timely diagnosis and treatment; this will improve the prognosis of the course of the disease.

The aims of the study was to determine blood plasma C-reactive protein concentrations correlated with the presence and severity of early surgical complications according to the Clavien-Dindo classification (1992) in cases of prosthetic repair of the anterior abdominal wall.

Materials and methods. This was a clinical prospective multicenter study conducted in 2018-2022. Patients with a non-strangulated hernia of the anterior abdominal wall (n=89) underwent a hernia defect repair with a "conventional" polypropylene mesh implant. The patients were divided into two groups depending on the presence of early surgical complications according to the Clavien-Dindo classification (1992). In the postoperative period, the patients underwent enzyme immunoassay of blood plasma for C-reactive protein, ultrasound scanning of the anterior abdominal wall tissues, and monitoring of local changes in the wound area. In 5 days after surgery, the groups were compared based on the criterion of blood plasma C-reactive protein concentration (within the reference values or exceeding them for more than > 5 mg/l).

Results. The excessive reference level of C-reactive protein in blood plasma (more than 5 mg/l) on the 5th day after prosthetic plastic surgery of the anterior abdominal wall correlated with a 30.3% (p<0.001, Fisher's exact test) higher rate of early surgical complications; of these, 73.1% of cases (p=0.014, Fisher's exact test) required invasive interventions (grade II complications according to the Clavien-Dindo classification). The presence of early surgical complications according to the the Clavien-Dindo classification correlated with an 8-fold (p<0.001, Mann-Whitney U test) higher concentration of C-reactive protein in blood plasma on the 5th day after prosthetic plastic surgery of the anterior abdominal wall (13.31 [6.12; 26.67] versus 1.68 [0.89; 3.99] in their absence).

Conclusions. C-reactive protein of blood plasma level exceeding > 5 mg/l on the 5th day after prosthetic repair of the anterior abdominal wall is a precursor of early surgical complications.