Postoperative C-Reactive Protein-to-Albumin Ratio as a Predictor of 90-Day Morbidity After Hartmann’s Reversal

After a major surgery to restore the natural flow of the intestines, the body enters a period of delicate recovery. For patients who have undergone a Hartmann's reversal—a complex procedure that reconnects the colon after a temporary stoma has been removed—the road back to health is often fraught with risk. This operation is technically demanding, requiring surgeons to navigate through scar tissue and carefully rejoin the bowel, and it carries a significant chance of complications such as infection or leakage at the connection site. Doctors have long relied on measuring C-reactive protein, a substance in the blood that rises when the body is fighting inflammation, to gauge how well a patient is healing. High levels of this protein in the days following surgery often signal that something is wrong. However, inflammation is only one side of the story. The body also consumes its own resources during the stress of surgery, particularly albumin, a protein that acts as a vital nutrient reserve and helps maintain the fluid balance in the blood. When a patient's body is under severe stress, albumin levels can drop. The question facing surgeons is whether looking at these two markers together—the rising inflammation and the falling nutritional reserve—provides a clearer warning sign than looking at either one alone.

A team of researchers at the Hospital General de México set out to test this idea in patients recovering from Hartmann's reversal. They reviewed the medical records of 86 adults who had undergone the procedure between 2019 and 2025. The goal was to see if a specific calculation, known as the C-reactive protein-to-albumin ratio, could predict which patients would develop serious complications within the first 90 days after surgery. This ratio is a simple mathematical combination: it takes the amount of the inflammatory marker found in the blood a few days after the operation and divides it by the amount of albumin the patient had before the surgery began. By doing this, the researchers created a single number that reflects both the intensity of the body's inflammatory response and the patient's underlying nutritional status. They checked this number on the third day after surgery and again on the fifth day to see if it could spot trouble early.

The study found that the body's reaction on the fifth day was the most telling. While the ratio on the third day showed some difference between patients who stayed healthy and those who got sick, the difference was not strong enough to be statistically significant. However, by the fifth day, the pattern became clear. Patients who went on to develop complications had a much higher ratio than those who recovered without issues. Specifically, the group that experienced complications had a ratio that averaged around 32.8, whereas the healthy group averaged around 19.9. This difference was large enough to be considered a real finding rather than a random fluctuation. The researchers calculated that for every ten-point increase in this ratio on the fifth day, the likelihood of a patient developing a complication increased by 65 percent. This association held true even when the researchers accounted for how long the surgery itself had taken, suggesting that the ratio was capturing something unique about the patient's recovery process rather than just reflecting the difficulty of the operation.

The ability of this ratio to distinguish between patients who would and would not get sick was moderate but promising. When the researchers analyzed the data to find the best point at which to separate the two groups, they identified a threshold of 28.77. If a patient's ratio on the fifth day was below this number, the test was quite good at ruling out the possibility of a major complication, correctly identifying healthy patients about 86 percent of the time. This high ability to rule out risk is valuable in a clinical setting, as it could help doctors feel more confident about discharging low-risk patients or reducing the intensity of their monitoring. Conversely, patients with a ratio above this threshold were more likely to face complications, signaling a need for closer observation. The study noted that the ratio performed better on the fifth day than on the third, suggesting that the full picture of a patient's inflammatory and nutritional struggle takes a few days to fully emerge after this specific type of surgery.

Despite these encouraging results, the authors are careful to note that this finding is not yet a final answer. The study was conducted at a single hospital with a relatively small number of patients, and the specific number used as a cutoff was derived from this particular group. This means the exact threshold of 28.77 might not apply directly to patients in other hospitals or different medical systems. The researchers emphasize that this ratio should not be used as a standalone diagnostic tool to declare a patient sick or well. Instead, it serves as a helpful addition to the clinical picture, offering a quantitative way to assess risk alongside physical exams and other tests. Before this method can be adopted into routine care, the results need to be tested in larger, more diverse groups of patients to confirm that the pattern holds true everywhere. For now, the study provides a strong suggestion that combining inflammation and nutritional markers on the fifth day after a Hartmann's reversal offers a meaningful glimpse into a patient's future recovery, potentially allowing for earlier and more targeted care for those who need it most.