Risk Factors for Postoperative Sepsis and Septic Shock in Patients Undergoing Emergency Surgery

Author(s):
Viktor Gabriel; Areg Grigorian; Jeffry Nahmias; Eugene Won; Nicole Bernal; Sebastian Schubl

Background:

Postoperative sepsis in emergency surgery is associated with mortality of up to 4.2%, significantly higher than for elective surgery (1.1%). Overall, total hospital costs increase by 2.3 times for patients that develop post-operative sepsis. This study aimed to identify risk factors for postoperative 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 2012-2015 and comparing those that developed sepsis with those that did not. Anal procedures and cases with pre-operative sepsis or septic shock were excluded. Multivariate logistic regression was used to identify risk factors for development of sepsis or septic shock in patients undergoing emergency surgery.

Results:

Out of 122,757 cases that met inclusion criteria, 1,448 developed sepsis and 962 septic shock. Risk factors for sepsis or septic shock were male gender (OR= 1.38, 95% CI 1.26-1.51, p<0.0001), American Society of Anesthesiologists (ASA) class 2 or higher (OR= 2.54, CI 1.94-3.32, p<0.0001), and partially dependent (OR= 1.62, CI 1.37-1.93, p<0.0001) or totally dependent (OR=1.77, CI 1.28-2.46, p =0.00062) functional status. Compared to colorectal procedures, patients undergoing pancreatic (OR= 3.57, CI 2.28–5.58, p<0.0001) and small intestine (OR= 1.30, CI 1.16–1.46, p<0.0001) surgery were more likely to develop sepsis or septic shock, whereas patients undergoing biliary (OR= 0.37, CI 0.30-0.53, p<0.0001) and thoracic (OR= 0.42, CI 0.22-0.79, p=0.008) procedures were less likely to develop septic complications.

Conclusions:

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