C-reactive protein is useful after bowel surgery because of its negative predictive value: a low value makes a significant anastomotic leak unlikely. It is a poor positive test, and a raised value alone diagnoses nothing. Clinical review — tachycardia, fever, ileus, new pain, rising lactate, a patient who simply is not progressing — overrides any biochemical threshold.
In practice, use the number to support discharge in a patient who is already well, never to reassure yourself about one who is not. A patient with a low CRP and clinical concern still needs a CT.
- Use a low CRP to support discharge only in a patient who is clinically well.
- Investigate clinical deterioration with CT regardless of a reassuring CRP.
- Treat tachycardia and new abdominal pain after day 2 as warning signs in their own right.
- Give patients clear advice on returning with fever, pain or vomiting after early discharge.
Why it matters
Early-discharge pathways only stay safe if the number never replaces the bedside review.
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