Optimizing Early Detection of Post-Operative Complications in Colorectal Surgery: A Meta-Analysis of Combined Inflammatory Markers

Abstract Post-operative complications, particularly anastomotic leaks, are a significant concern in colorectal surgery, and early identification through inflammatory markers like C-reactive protein (CRP), white blood cell (WBC) count, neutrophils, and stool calprotectin can improve patient outcomes. This meta-analysis evaluates the diagnostic accuracy of these markers in predicting post-operative complications, especially anastomotic leaks, by analyzing data from 51 studies including 49,328 patients. CRP levels exceeding 145 mg/L on the third post-operative day demonstrated 85% sensitivity and 75% specificity for predicting anastomotic leaks. The combined use of CRP, WBC greater than 12,000 cells/µL, and neutrophils increased diagnostic performance to 90% sensitivity and 80% specificity. Additionally, stool calprotectin levels greater than 200 µg/g provided predictive value when CRP results were inconclusive, with 82% sensitivity and 78% specificity. Moderate heterogeneity (I² = 45%) was observed, with minimal publication bias. The findings suggest that CRP, when combined with WBC and neutrophils, is a strong predictor of post-operative complications, including anastomotic leaks, while stool calprotectin offers added diagnostic value in uncertain cases. Incorporating these markers into post-operative monitoring may enhance early detection and improve patient outcomes