2025/07/01 by Doruk Orgun, Christina Ellervik, Henrik E. Poulsen +3 · 1 voice
Medicine · #Cardiac, Anesthesia and Surgical Outcomes #Colorectal Cancer Surgical Treatments #Enhanced Recovery After Surgery
paper · doi:10.1093/bjsopen/zraf087
openalex publication_date 2025/07/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
BACKGROUND: Although overt systemic inflammation immediately before gastrointestinal surgery has been associated with postoperative complications and mortality, it remains unclear whether baseline low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) in a non-surgery-related state is associated with the same outcomes. METHODS: This study included a subset of individuals from the Copenhagen General Population Study (CGPS) who underwent any type of gastrointestinal surgery between 2003 and 2015 after enrolment in the CGPS. Exposures were baseline hs-CRP levels (used in observational analyses) and two genetic variants that affect hs-CRP levels, namely interleukin 6 receptor (IL6R) rs4537545 and CRP rs1130864 (used in Mendelian randomization analyses), all of which were tested routinely at CGPS enrolment. Primary outcomes were 30-day complications and 90-day and 5-year mortality after the index surgery. Associations between exposures and outcomes were assessed using multivariable Cox regression models. RESULTS: Of the 107 536 individuals in the CGPS, 12 803 were included in the present study. Of these individuals, 1236 (9.7%) experienced 30-day complications, 865 (6.8%) died within 90 days, and 2789 (21.8%) died within 5 years. Adjusted hazard ratios for the highest hs-CRP quartile (hs-CRP ≥ 2.73 mg/l) versus the lowest quartile (hs-CRP < 1.04 mg/l) were 1.19 (95% confidence interval (c.i.) 1.02 to 1.40; P = 0.029) for 30-day complications, 1.29 (95% c.i. 1.07 to 1.57; P = 0.009) for 90-day mortality, and 1.17 (95% c.i. 1.06 to 1.31; P = 0.003) for 5-year mortality. Sensitivity analyses restricted to those with hs-CRP measurements within 1 year before surgery had larger point estimates. Genetically predicted elevations in hs-CRP were not associated with any outcomes. CONCLUSION: Baseline hs-CRP levels ≥ 2.73 mg/l, consistent with chronic low-grade systemic inflammation, were associated with higher risk of 30-day complications, 90-day mortality, and 5-year mortality after gastrointestinal surgery.