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

Abstract

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.

Incidence, Risk Factors and Outcomes of Sepsis in Critically Ill Post-craniotomy Patients: A Single-Center Prospective Cohort Study

“…In their study, the incidence of sepsis in patients undergoing craniotomy was 1.21%. Zhang et al, also using the ACS NSQIP database, reported a 1.35% incidence of sepsis in patients undergoing craniotomy for tumor resection ( 20 ). Compared with the incidence of sepsis in the above two studies, the incidence of sepsis in our study was much higher.…”

“…In addition, most of their patients underwent spine procedures, while patients undergoing cranial procedures only accounted for 22.2% of the population. Zhang et al, reported the incidence of sepsis in patients who underwent craniotomy for tumor resection, but not in patients who underwent craniotomy for other reasons ( 20 ). Therefore, the results of both studies could not reflect the overall epidemiological characteristics of sepsis after neurosurgery.…”

Body Mass Index Has a Nonlinear Association With Postoperative 30-Day Mortality in Patients Undergoing Craniotomy for Tumors in Men: An Analysis of Data From the ACS NSQIP Database

“…The data studied obtained from the ACS NSQIP database originally uploaded by Jingwen Zhang et al. ( 13 ) (data from “Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure”; DOI: ). The original study was an open-access article distributed under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.…”

“…The 30-day mortality was defined as mortality after discharge for the first 30 postoperative days ( 13 ).…”

“…Thus, the following variables were treated as covariates: (1) continuous variables: preoperative blood test indicators (serum sodium, blood urea nitrogen, white blood cell count, hematocrit, platelet count), BMI and duration of the operation; and (2) categorical variables: sex (female or male), race (Asian, White, African American or Unknown), age ranges (18-40, 41-60, 60-80, >80 years old), smoking status, ventilator dependence, steroid use, preoperation transfusions, and emergency case status, and a history of diabetes [No, Yes (Noninsulin-dependent) or Yes (Insulin-dependent)], severe chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension, renal failure, disseminated cancer, and open wound infection. More specific details are presented in the original study ( 13 ). In addition, WBC counts less than or equal to 10 × 10 9 /L were considered low risk, and those greater than 10 × 10 9 /L were considered high risk ( 15 ).…”