Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

Lakomkin, Nikita; Sathiyakumar, Vasanth; Wick, Brandon; Shen, Michelle; Jahangir, A. Alex; Mir, Hassan R.; Obremskey, William T.; Dodd, Ashley C.; Sethi, Manish K.

doi:10.1007/s10195-016-0437-4

Cited by 26 publications

(24 citation statements)

References 51 publications

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“…Preoperative mechanical ventilation, SIRS, functional status, bleeding disorders, as well as severe COPD were all significant preoperative factors associated with S/SS for craniotomy for brain tumor resection. These results are similar to previous studies [ 14 , 17 , 18 ]. Additionally, steroid use for a chronic condition has been shown to be closely related to the development of both postoperative infections [ 19 – 21 ] and postoperative S/SS [ 17 ], which is consistent with our data.…”

Section: Discussionsupporting

confidence: 93%

“…These results are similar to previous studies [ 14 , 17 , 18 ]. Additionally, steroid use for a chronic condition has been shown to be closely related to the development of both postoperative infections [ 19 – 21 ] and postoperative S/SS [ 17 ], which is consistent with our data. This is likely due to the potential to induce immune-suppression and adrenocortical suppression of corticosteroids [ 22 ].…”

Section: Discussionsupporting

confidence: 93%

“…A preoperative diagnosis of ascites was the factor most associated with the development of postoperative S/SS in this study, with OR of 33.0, far more than any other predictors. Other papers have also discussed ascites, however, found ORs no more than 5 [ 14 , 17 ]. Our data would suggest that serious consideration should be had regarding treatment of ascites prior to undertaking craniotomy for tumor resection.…”

Section: Discussionmentioning

confidence: 99%

“…Other predictors, such as operative time greater than 310 minutes, male gender, hypertension, BMI as well as ASA classification, were also found to be associated with the S/SS in this study. Although many of these have been reported in a number of papers [ 10 , 17 , 23 – 27 ], their cohorts did not focus specifically on craniotomy on brain tumor resection. Identification of these factors warrants consideration of strategies to improve efficiency and decrease the amount of time a patient is on the operating table and may lead a clinician to consider medical optimization of hypertension, BMI and ASA classification prior to elective operations if possible.…”

Section: Discussionmentioning

confidence: 99%

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Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Zhang

Pieters

et al. 2020

PLoS ONE

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Objectives Sepsis and septic shock are important quality and patient safety metrics. This study examines incidence of Sepsis and/or septic shock (S/SS) after craniotomy for tumor resection, one of the most common neurosurgical operations. Methods Multicenter, prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify patients undergoing craniotomy for tumor (CPT 61510, 61521, 61520, 61518, 61526, 61545, 61546, 61512, 61519, 61575) from 2012–2015. Univariate and multivariate logistic regression models were used to identify risk factors for S/SS. Results There were 18,642 patients that underwent craniotomy for tumor resection. The rate of sepsis was 1.35% with a mortality rate of 11.16% and the rate of septic shock was 0.65% with a 33.06% mortality rate versus an overall mortality rate of 2.46% in the craniotomy for tumor cohort. The 30-day readmission rate was 50.54% with S/SS vs 10.26% in those without S/SS. Multiple factors were identified as statistically significant ( p <0.05) for S/SS including ascites (OR = 33.0), ventilator dependence (OR = 4.5), SIRS (OR = 2.8), functional status (OR = 2.3), bleeding disorders (OR = 1.7), severe COPD (OR = 1.6), steroid use (OR = 1.6), operative time >310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), ASA class ≥ 3 (OR = 1.4), male sex (OR = 1.4), BMI >35 (OR = 1.4) and infratentorial location. Conclusions The data indicate that sepsis and septic shock, although uncommon after craniotomy for tumor resection, carry a significant risk of 30-day unplanned reoperation (35.60%) and mortality (18.21%). The most significant risk factors are ventilator dependence, ascites, SIRS and poor functional status. By identifying the risk factors for S/SS, neurosurgeons can potentially improve outcomes. Further investigation should focus on the creation of a predictive score for S/SS with integration into the electronic health record for targeted protocol initiation in this unique neurosurgical patient population.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Zhang

Pieters

et al. 2020

PLoS ONE

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“…None of the patient was in need of dialysis. Sepsis was as well observed in frequencies comparable to those in literature [14,15].…”

Section: Discussionsupporting

confidence: 84%

Early Outcomes of Pelvic Trauma Patients – Complications, ICU Stay and Treatment Concepts in Two ATLS® Compliant Trauma Centers: Germany and Qatar

Keil

El‐Menyar

Daerr

et al. 2020

Preprint

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Background: Pelvic trauma causes severe threats especially to polytraumatized patients. Not only it is in itself a possible cause for significant bleeding but it also indicates a high risk for intra-abdominal injuries. The initial treatment of patients with pelvic trauma follows the ATLS principles of priority-oriented treatment. To examine the value of this highly standardized concept and to evaluate the effect of different patient collectives on early outcome parameters, two large collectives from Germany and Qatar were analyzed regarding injury parameters and early outcomes.Methods: Patients were recruited in Hamad General Hospital, Doha, Qatar (HGH) and BG Trauma Center Ludwigshafen, Germany (BG). All patients that were treated with a pelvic fracture between 2013 and 2016 were included in this retrospective analysis. Demographic parameters were collected as well as type of injury and the frequency of complication parameters as pneumonia, acute kidney failure, ARDS, sepsis and amount of blood transfusion.Results: We recruited 1436 patients with pelvic fracture (645 from BG and 791 from HGH). The mean age was 57.4 years in the BG and 33.6 years in the HGH group (p<0.000). The mean ISS was 17.81 in the BG and 15.88 in the HGH group (p=0.009). The mean pelvic AIS was 2.65 in the BG and 2.25 in the HGH group (p<0.000). The mean frequency of complications was 9.3% in the BG and 9.9% in the HGH group (p=0.128). The mean frequency of ARDS was significantly higher in the BG group than in the HGH group (5.6% vs. 1.8%, p<0.000). The mean frequency of blood transfusion was significantly lower in the BG group than in the HGH group (28.8% vs. 39.2%, p<0.000).Discussion and Conclusion: Despite significant differences in the two collectives, this analysis shows comparable results regarding early outcome parameters in patients with pelvic injuries. In total, pelvic injuries are accompanied by a relatively high complication risk and need to be evaluated and treated according to priority-based algorithms.

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Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

Kobes

Sweet

Klip

et al. 2022

Eur J Trauma Emerg Surg

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Background In-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown. Purpose To assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center. Methods All trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale. Results In total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications. Conclusion Coronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.

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Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

Cited by 26 publications

References 51 publications

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Early Outcomes of Pelvic Trauma Patients – Complications, ICU Stay and Treatment Concepts in Two ATLS® Compliant Trauma Centers: Germany and Qatar

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

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