Risk Factors and Outcomes for Sepsis Following Appendectomy

Author(s):
I. Michael Leitman; Jeanie Gribben; Allen Ninh; Anthony Bui

Background:

Sepsis is an uncommon occurrence following appendectomy, but the morbidity and mortality of patients who develop sepsis remain high. The purpose of this study is to identify risk factors and outcomes associated with sepsis following appendectomy.

Methods:

The American College of Surgery National Surgical Quality Improvement Program participant user database was queried from 2012 to 2015. Patients who underwent appendectomy were identified and demographic data, intraoperative variables, and postoperative outcomes were collected. The primary outcome was postoperative sepsis following appendectomy, which was defined as the development of SIRS/Sepsis/Septic Shock postoperatively. Patients who had sepsis within 48 hours prior to surgery or was present at the time of surgery were excluded. Multivariate analyses (logistic and linear regression) were performed to assess for risk factors and outcomes associated with sepsis.

Results:

Of the 104138 patients that had appendectomy, 541 patients (0.52%) were identified to have postoperative sepsis. Age greater than 60 (OR=2.07, 95% CI=1.67-2.56), African Americans (OR=1.86, 95% CI=1.44-2.40), history of hypertension (OR=1.63, 95% CI=1.31-2.02), morbid obesity (BMI≥40 or BMI≥35 with hypertension or diabetes) (OR=1.54, 95% CI= 1.20-1.98), and renal failure or dialysis (OR=4.01, 95% CI=2.37-6.79) were found to be associated with increased risk of sepsis. 27 patients (5%) expired within 30 days. Postoperative sepsis following appendectomy is associated with increased risk of 30-day mortality (OR=26.77, 95% CI=16.78-42.71) as well as an average of 5.27 days increased length of stay (95% CI=5.01-5.52). Postoperative sepsis was found to be associated with increased risk of pneumonia (OR=35.63, 95% CI=26.47-47.97), unplanned reintubation (OR=40.04, 95% CI=29.10-55.09), pulmonary embolism (OR=9.74, 95% CI=4.41-21.52), ventilation for >48 hours postoperatively (OR=56.84, 95% CI=39.81-81.15), cerebrovascular accidents (OR=13.46, 95% CI=3.85-47.26), cardiac arrest (OR=14.42, 95% CI=6.81-30.54), myocardial infarction (OR=9.99, 95% CI=4.84-20.64) and deep vein thrombosis (OR=6.12, 95% CI=4.09-9.88).

Conclusions:

Patients that experience sepsis following appendectomy are at significant risk for adverse postoperative morbidity and mortality. Given the remarkably large number of appendectomies that are performed each year, the findings of this study can aid in the adjustments of current protocols to further reduce the incidence of sepsis following appendectomy.