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Medical Forum / General / General / August 2008Do surgeons order CRP levels after surgery
Do surgeons order CRP levels q8h after surgery to monitor inflammation, in case the healthy inflammation of the wound healing process goes awry? Do they also prescribe prophylactic antibiotics, like amoxicillin, to prevent infection of surgical wounds? > Do surgeons order CRP levels q8h after surgery to monitor > inflammation, in case the healthy inflammation of the wound healing > process goes awry? Do they also prescribe prophylactic antibiotics, > like amoxicillin, to prevent infection of surgical wounds? No to CRP. As to prophylactic antibiotics, the answer is "sometimes", depending on the nature of the operation. Antibiotics are commonly used in cases where the patient has articificial joints or heart valves, in cases where some artificial device is being implanted (such as hernia mesh), or in cases where they may be cutting across the gastrointestinal tract. HMc > > Do surgeons order CRP levels q8h after surgery to monitor > > inflammation, in case the healthy inflammation of the wound healing [quoted text clipped - 10 lines] > > HMc So, they don't order CRP, what about ESR? > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 18 lines] > > - Show quoted text - The only time CRP is used for infections is in newborns where other other laboratory indicators may be lacking. Serial CRP testing is more significant than single testing. CRP and sedrates are similar but not identical and denote all forms of inflammation and not just infection. > > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 27 lines] > > - Show quoted text - That's what I meant. Post-surgical inflammation could also be caused by things other than infection. Isn' it good to track that? On Aug 18, 4:53 pm, Robert1 <Goldentouch...@yahoo.com> wrote: > On Aug 18, 12:29 pm, Protoman <Protoman2...@gmail.com> wrote: > >That's what I meant. Post-surgical inflammation could also be caused > >by things other than infection. Isn' it good to track that? No, it's pretty much pointless to check CRP or ESR. Surgery itself causes inflammation. CRP and ESR are too non-specific to be useful...will virtually always be elevated after an operation. HMc \ > On Aug 18, 4:53 pm, Robert1 <Goldentouch...@yahoo.com> wrote: > [quoted text clipped - 8 lines] > > HMc The good doc is right. Not only that, but there are better things to check, like how well the patient is progressing, his/her heart rate, respiratory rate and listening to the lungs and looking at the wound. And, the doctor can even ask the patient how he/she is doing and listen to the patient. This will give better information that poking the patient for a level that we know is going to be elevated anyway. Jeff > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 20 lines] > > Jeff What about checking it after the wound is supposed to have healed? > > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 22 lines] > > What about checking it after the wound is supposed to have healed? Why? It is much easier to look at the patient, listen to the lungs, heart, etc., look at the wound, see how the patient is doing and talk with the patient. More harm than good is likely to come from testing the CRP. If the CRP is going to be high from surgery-related issues, good physical exam, like listening to the lungs for signs of problems related to breathing (e.g., sometimes atelectasis occurs when parts of the lungs collapse), looking at the wound to make sure it is healing properly, seeing how well the patient moves around, talking with the patient will tell the surgeon far more useful stuff than looking at a number on a lab test. Not that lab tests are not important, but a good physician or surgeons picks the right lab tests and listens to his/her patients. Jeff > > > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 43 lines] > > - Show quoted text - I meant in addition to all of that, my friend. Lab tests can't do everything! > > > > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 46 lines] > I meant in addition to all of that, my friend. Lab tests can't do > everything! A high CRP or ESR won't add anything to what a surgeon already knows. The surgeon already knows that there is a lot of inflammation. So the test won't add any useful information. Doing a test where there is no added clinically useful information is a waste of time and resources. So there is no need to do the test because it doesn't add any clinically useful information. Jeff >>>So there is no need to do the test because it doesn't add any >>>clinically useful information. >>>Jeff Yes, that's the bottom line. Waste of time, waste of money. HMc > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 20 lines] > > Jeff >>>What about checking it after the wound is supposed to have healed? What relevant information do you think could be obtained from such a test, and how would a doctor apply that information clincally? HMc > > > "Protoman" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 28 lines] > > - Show quoted text - If CRP is still elevated after the surgical site should've healed, plus there are still signs of inflammation present at the surgical site, or the chirurgical site appears infected, the surgeon should take a wound culture, and prescribe appropriate antibiotics and possibly anti-inflammatories or immunosupressants. Checking the CRP level could alert the surgeon to look for such a situation, esp. if the surgical site is occult or the patient is unresponsive. <...> > If CRP is still elevated after the surgical site should've healed, > plus there are still signs of inflammation present at the surgical [quoted text clipped - 3 lines] > level could alert the surgeon to look for such a situation, esp. if > the surgical site is occult or the patient is unresponsive. In theory, true. In practice, the surgeon should already be aware of these conditions from physical exam. The CRP adds nothing that a good physical exam doesn't. The CRP adds no useful information to surgeon. Jeff > <...> > [quoted text clipped - 11 lines] > > Jeff Yes, but if it's a patient in the SICU, and the surgeon has a full OR schedule, at many different hospitals, wouldn't it be quicker to have a CRP done on his patients, so he can be alerted if pathological inflammation occurs. It'd be alot simpler to run a lab test than have to drive maybe an hour to do a physical exam; although I suppose the chirurgeon could have a physician at his pat's hospital to do the exam for him. > > <...> > [quoted text clipped - 19 lines] > chirurgeon could have a physician at his pat's hospital to do the exam > for him. No. Because if a patient is that sick, the patient needs to be seen by the surgical and/or medical staff, as well as nursing staff, who should be able to spot a poorly healing wound quickly. In addition, the vast majority of SICUs are in teaching hospitals, which means that there should be residents, interns and medical students who are also watching the case. Just why are you asking this, anyway? Personally, I would be concerned about having a surgeon who relies on lab tests instead of physical exam and talking to people, in this case, including the patient, patient's familiy, nursing, medical, surgical and house staff (i.e., interns and residents). Jeff > > > <...> > [quoted text clipped - 37 lines] > > - Show quoted text - For academic purposes; I'll observing at a hospital shortly. On Aug 18, 7:05 am, "Howard McCollister" <nos...@nospam.net> wrote: > As to prophylactic antibiotics, the answer is "sometimes", depending on > the [quoted text clipped - 4 lines] > > HMc > >So, they don't order CRP, what about ESR? No. Waste of time, waste of money. No clinical value in checking these things. HMc >> Do surgeons order CRP levels q8h after surgery to monitor >> inflammation, in case the healthy inflammation of the wound healing [quoted text clipped - 10 lines] > > HMc I know the AHA has drastically decreased their indications for prophylactic antibiotics as of last April. I know the changes for dental procedures--I think they were lumped together with genitourinary procedures. I figure you know what's what for intestinal procedures. ;-) I'm close to making a decision to have my inguinal hernias repaired. I think I'm almost the exact age my dad was when he had his done. I just want to wait until after the hay fever season. ;-) Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I know the AHA has drastically decreased their indications for > prophylactic antibiotics as of last April. I know the changes for dental [quoted text clipped - 3 lines] > think I'm almost the exact age my dad was when he had his done. I just > want to wait until after the hay fever season. ;-) Assuming they're going to repair those hernias laparoscopically (as they should) using prosthetic mesh, then a single dose of pre-op antibiotics is indicated. HMc > Assuming they're going to repair those hernias laparoscopically (as they > should) using prosthetic mesh, then a single dose of pre-op antibiotics is > indicated. > > HMc Thanks for the reply, Doc! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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