Background: The performance of most colorectal procedures within an enhanced recovery after surgery (ERAS) programs has resulted in significant advantages, including a reduction in the length of hospital stay to 4-6 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute phase parameters determined 24, 48 and 72 hours after laparoscopic colorectal surgery (LCS), for predicting septic complications, such a surgical site infection (SSI) and anastomotic leak (AL), in the postoperative course. 
Design: A prospective study of 128 patients who underwent LCS within an ERAS program between 2014 and 2015 was performed. The clinical variables investigated were septic complications (surgical site infection (SSI) and anastomotic leak). Acute phase parameters (procalcitonin and c-reactive protein (CRP)), and white blood cell (WBC) count were determined in the blood sample extracted 24, 48 and 72 hours after surgery. 
Receiver operating characteristic (ROC) curve analysis was performed, and the respective areas under the curve (AUC) were calculated to evaluate the predictive value CRP level, procalcitonin level, and WBC count for the diagnosis of septic complication. The sensitivity and specificity of these parameters were calculated.
Results: Septic complications were observed in 15 patients (11,7 %), 6 SSI ( 4,7 %) and 9 AL (7 %). Using ROC analysis, on 24 hours postoperatively a cutoff level of procalcitonin at 0,4 ng/ml achieved 100% sensitivity and 85% specificity for predicting septic complications. On 48 hours postoperatively a cutoff level of procalcitonin at 0,5 ng/ml achieved 90 % sensitivity and 85% specificity for predicting septic complications. On 72 hours postoperatively a cutoff level of CRP at 200 mg/l and procalcitonin at 0,5 ng/ml achieved 75 % sensitivity and 85% specificity for predicting septic complications. 
Conclusions: The use of procalcitonin, in the first day and in the second day postoperative, can predict septic complications after LCS. In the third day, CRP and procalcitonin also can predict septic complications after LCS. This is mainly interesting in patients within an ERAS program that will be discharged early.

Procalcitonin and C-Reactive Protein as early markers of septic complications after laparoscopic colorectal surgery within an ERAS program: a prospective observational study