Risk Factors for Post-Operative Sepsis and Septic Shock in Patients Undergoing Emergency Surgery.

Authors:
Viktor Gabriel
Viktor Gabriel
David Geffen School of Medicine
United States
Areg Grigorian
Areg Grigorian
San Diego School of Medicine
Jeffry Nahmias
Jeffry Nahmias
Baystate Medical Center
Marija Pejcinovska
Marija Pejcinovska
Center for Statistical Consulting
United States
Megan Smith
Megan Smith
Yale University School of Medicine
Beatrice Sun
Beatrice Sun
Cedars-Sinai Medical Center
Eugene Won
Eugene Won
North Carolina State University
United States
Nicole Bernal
Nicole Bernal
Cincinnati Children's Hospital Medical Center

Surg Infect (Larchmt) 2019 Apr 5. Epub 2019 Apr 5.

4 Department of Division of Trauma, Burns, Acute Care Surgery, and Surgical Critical Care, University of California, Irvine, Orange, California.

Background: Sepsis after emergency surgery is associated with a higher mortality rate than elective surgery, and total hospital costs increase by 2.3 times. This study aimed to identify risk factors for post-operative sepsis or septic shock in patients undergoing emergency surgery.

Methods: A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program (NSQIP) by identifying patients undergoing emergency surgery between 2012 and 2015 and comparing those who developed post-operative sepsis or septic shock (S/SS) with those who did not. Patients with pre-operative sepsis or septic shock were excluded. Multiple logistic regression was used to identify risk factors for the development of S/SS in patients undergoing non-elective surgery.

Results: Of 122,281 patients who met the inclusion criteria, 2,399 (2%) developed S/SS. Risk factors for S/SS were American Society of Anesthesiologists Physical Status (ASA PS) class 2 or higher (odds ratio [OR] 2.57; 95% confidence interval [CI] 2.19-3.02; p < 0.0001), totally dependent (OR 2.00, 95% CI 1.38-2.83; p = 0.00021) or partially dependent (OR 1.62, 95% CI 1.35-2.00; p < 0.0001) functional status, and male gender (OR 1.31; 95% CI 1.18-1.45; p < 0.0001). Compared with colorectal procedures, patients undergoing pancreatic (OR 2.33, CI 1.40-3.87; p = 0.00108) and small intestine (OR 1.27; CI 1.12-1.44; p = 0.00015) surgery were more likely to develop S/SS. Patients undergoing biliary surgery (OR 0.38; CI 0.30-0.48; p < 0.0001) were less likely to develop S/SS.

Conclusions: Risk factors for the development of sepsis or septic shock are ASA PS class 2 or higher, partially or totally dependent functional status, and male gender. Emergency pancreatic or small intestinal procedures may confer a higher risk. Greater vigilance and early post-operative screening may be of benefit in patients with these risk factors.

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Source
https://www.liebertpub.com/doi/10.1089/sur.2018.186
Publisher Site
http://dx.doi.org/10.1089/sur.2018.186DOI Listing
April 2019
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