Using C-reactive protein (CRP) for earlier detection of Infectious complications following Colorectal Surgery

Interventions: Prospective, non-randomised, non-blinded clinical trial comparing two patient groups over two consecutive time periods.
Group 1 (Standard Care) – Patients have CRP levels measured on postoperative days 3 to 5 via a simple peripheral venous blood test which will be collected by a phlebotomist or doctor from the surgical team. A septic screen is performed based on the patients clinical status (vital signs, examination findings) rather than CRP alone.
Group 2 (CRP protocol group) - Patients have CRP levels measured on postoperative days 3 to 5 as for Group 1. If the CRP value is above certain thresholds on these days (>170mg/L on day 3, >125mg/L on day 4, or >50mg/L increase between day 3 and 4, or between day 4 and 5), a ‘septic screen’ will be performed on the same day to look for a source of infection regardless of normal vital signs or examination findings. This will include:
- CT scan of the abdomen and pelvis
- Chest x-ray
- Cultures of urine, wound and blood/central lines
Fidelity of this data will be ensured through prospective collection of CRP data and complications and further assessed through audit of electronic records and hospital notes at the end of the study.
Primary outcome(s): Infectious complications (e.g. wound infection, chest infection, urinary tract infection, anastomotic leak, abdominal collection).
These will be assessed by the surgical team as part of routine clinical care and postoperative follow-up. They will be prospectively recorded by the principal investigator and research team.[Assessed daily while in hospital and then weekly once discharged until 30 days post surgery.]
Study Design: Purpose: Diagnosis; Allocation: Non-randomised trial