C-reactive protein levels for early detection of postoperative infection after fracture surgery in 787 patients.

BACKGROUND AND PURPOSE: For early detection of postoperative infections, the level of C-reactive protein (CRP) may be useful. We analyzed baseline and time-dependent reference values for the postoperative use of CRP as an indicator of infection.

METHODS

We studied the kinetics of CRP levels after fracture surgery in 1,418 patients. In 787 cases the operative fracture treatment was uneventful; in 17 of the other cases a deep wound infection occurred.

RESULTS

In the uneventful cases, a similar evolution in CRP concentrations was found: the peak level, which occurred on the second postoperative day, depended on the region (136 mg/L in femoral fractures and 45 mg/L in ankle fractures) and reflected the extent of surgical trauma. For deep wound infection, a cutoff level of 96 mg/L (sensitivity 92%, specificity 93%) after the fourth day of surgery was recorded.

INTERPRETATION: CRP kinetics permit establishment of a time-dependent set of reference values of CRP after operative fracture treatment. Deviations of this course--especially CRP concentrations above 96 mg/L after the fourth day--may aid in early detection of surgical complications.