The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study

Ou, Lixin; Chen, Jack; Hillman, Ken; Flabouris, Arthas; Parr, Michael; Assareh, Hassan; Bellomo, Rinaldo

doi:10.1186/s13054-016-1596-7

Cited by 44 publications

(48 citation statements)

References 35 publications

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“…Importantly, the present study has shown that, despite the apparent success of surviving major perioperative complications, this does not equate to long‐term success as such complications continue to affect mortality. This has also been demonstrated more widely in international cohorts of patients undergoing elective surgery, where postoperative sepsis has been found to be independently associated with postdischarge mortalilty.…”

Section: Discussionmentioning

confidence: 71%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

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Background: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. Methods: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. Results: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48⋅1 per cent had stage III disease and cancer recurred in 428 patients (38⋅9 per cent). Complications of grade III or higher occurred in 244 patients (22⋅2 per cent). The most common complications were pulmonary (29⋅9 per cent), with a 13⋅0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10⋅0 and 9⋅6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19⋅7 versus 42⋅7 months; P < 0⋅001) and disease-free survival (18⋅4 versus 36⋅4 months; P < 0⋅001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. Conclusion: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival. Statistical analysisContinuous variables are described as median (i.q.r. or range) or mean(s.d.), and were compared using the Mann-Whitney U test and Student's t test respectively. The χ 2 test was used for analysis of discrete data. OS was

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Section: Discussionmentioning

confidence: 71%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

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“…Plenty of evidences have indicated that sepsis is a robust predictor of increases in short-term and long-term mortality for postsurgical patients (7,15,22,23). A large nationwide epidemiology of patients with elective surgery revealed an increased incidence of postoperative sepsis, ranging from 0.3% in 1997 to 0.9% in 2006, while they found that the in-hospital morality significantly decreased from 1997 to 2006 (44.4-30%) (22).…”

Section: Relation To Other Workmentioning

confidence: 99%

“…It has been documented that there are approximately 30% of septic patients after surgical procedures, and the proportions of patients who developed postoperative sepsis increase annually (4,5). Given the high prevalence and poor prognosis, the Agency for Healthcare Research and Quality (AHRQ) defined the 'postoperative sepsis' as a critical indicator for patients' safety, which mainly focused on preventable surgical complications and iatrogenic events after surgical procedures (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there were insufficient clinical trials that specifically testified the guidelines in the postoperative sepsis cohort. Most of the studies examined the short-term mortality in septic patients admitted to emergency department or intensive care unit (ICU) that contained all types of sepsis (7,14,15). On the contrary, few studies specifically targeted ICU surgical patients complicated with postoperative sepsis and their clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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A machine learning-based prediction of hospital mortality in patients with postoperative sepsis

Yao

Jin²,

Wang

et al. 2020

Preprint

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Background: The incidence of postoperative sepsis is continually increased, while few studies have specifically focused on the risk factors and clinical outcomes associated with the development of sepsis after surgical procedures. The present study aimed to develop a mathematical model for predicting the in-hospital mortality among patients with postoperative sepsis.Methods: Surgical patients in Medical Information Mart for Intensive Care (MIMIC-III) database who simultaneously fulfilled Sepsis 3.0 as well as Agency for Healthcare Research and Quality (AHRQ) criteria during ICU admission were incorporated. We employed both extreme gradient boosting (XGBoost) and stepwise logistic regression model to predict in-hospital mortality among included patients with postoperative sepsis. Consequently, model performance was assessed from the angles of discrimination and calibration.Results: We included 3713 patients who fulfilled our inclusion criteria, in which 397 (10.7%) patients died during hospitalization, while 3316 (89.3%) of them survived through discharge. Fluid-electrolyte disturbance, coagulopathy, renal replacement therapy (RRT), urine output, and cardiovascular surgery were important features related to the in-hospital mortality. The XGBoost model had a better performance in both discriminatory ability (c-statistics, 0.835 [95% CI, 0.786 to 0.877] vs. c-statistics, 0.737 [95% CI, 0.688 to 0.786]) and goodness of fit (visualized by calibration curve) compared to the stepwise logistic regression model. Conclusion: XGBoost model appears to be a better performance in predicting hospital mortality among postoperative septic patients compared to the conventional stepwise logistic regression model. Machine learning-based algorithm might have significant application in the development of early warning system for septic patients following major operations.

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“…The release of in ammatory factors is associated with postoperative complications including increased risk of postoperative infections (4)(5)(6)(7). In turn, sepsis is associated with increased rates of postoperative mortality, prolonged hospital stay, and increased health care costs (8).…”

Section: Introductionmentioning

confidence: 99%

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

Sterner¹,

Fisher²,

Thelaus³

et al. 2020

Preprint

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Background Surgical trauma and cardiopulmonary bypass (CPB) cause an inflammatory response, difficult to differentiate from postoperative infections. Heparin-binding protein (HBP) is released from neutrophils and has been shown to predict infection-related organ dysfunction and disease progression to severe sepsis. The aim of this study was to investigate the pre-, intra- and postoperative dynamics of HBP in cardiac surgery using CPB, in order to explore the usefulness of HBP as a biomarker for postoperative infections. Methods and Results Thirty patients undergoing cardiac surgery with CPB were included, of which 15 underwent coronary artery bypass grafting (CABG) surgery and 15 underwent complex procedures with longer CPB time. A reference group of ten patients undergoing lung surgery without CPB was also included. HBP was measured at nine different time points during surgery. Our results showed that HBP levels were not affected by surgical trauma itself. An increase in HBP levels was observed immediately following heparin administration and further increased during CPB. Prior to protaminization, we measured higher peak in HBP-levels in the complex group 345.7 (287.8-472.6) ng/mL compared with the CABG group 152.7 (85.3-204.0) ng/mL, p <0.001. HBP decreased rapidly following end of CPB and simultaneous protamine administration. Delay of protamine administration revealed that protamine, and not the cessation of CPB is primarily responsible for the rapidly reduced HBP concentration. At the arrival to the ICU, the median HBP levels were 24.8 (15.6-38.1) ng/mL for CABG patients compared with 50.5 (36.5-104.6) ng/mL for complex surgery patients ( p =0.004). One day after surgery HBP levels in all three groups were below the proposed cutoff of 30 ng/mL previously found to predict development organ dysfunction during infection. There was a statistically significant correlation between CPB duration and peak HBP concentration (r=0.598, p =0.002). Conclusions HBP levels are elevated by administration of heparin and the use of CPB. However, at postoperative day one, HBP levels normalized regardless of surgical complexity, indicating that postoperative HBP measurement may be used as a screening tool for postoperative infections in cardiac surgery.

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The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study

Cited by 44 publications

References 35 publications

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

A machine learning-based prediction of hospital mortality in patients with postoperative sepsis

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

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