1 Department of Surgery, University of California, Irvine, Orange, California.
2 Department of Statistics UC Irvine Center for Statistical Consulting, University of California, Irvine, Orange, California.
Surg Infect (Larchmt). 2019 Jul;20(5):367-372. doi: 10.1089/sur.2018.186. Epub 2019 Apr 5.
Sepsis after emergency surgery is associated with a higher mortality rate than elective surgery, and total hospital costs increase by 2.3 times. This study aimed to identify risk factors for post-operative sepsis or septic shock in patients undergoing emergency surgery. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program (NSQIP) by identifying patients undergoing emergency surgery between 2012 and 2015 and comparing those who developed post-operative sepsis or septic shock (S/SS) with those who did not. Patients with pre-operative sepsis or septic shock were excluded. Multiple logistic regression was used to identify risk factors for the development of S/SS in patients undergoing non-elective surgery. Of 122,281 patients who met the inclusion criteria, 2,399 (2%) developed S/SS. Risk factors for S/SS were American Society of Anesthesiologists Physical Status (ASA PS) class 2 or higher (odds ratio [OR] 2.57; 95% confidence interval [CI] 2.19-3.02; p < 0.0001), totally dependent (OR 2.00, 95% CI 1.38-2.83; p = 0.00021) or partially dependent (OR 1.62, 95% CI 1.35-2.00; p < 0.0001) functional status, and male gender (OR 1.31; 95% CI 1.18-1.45; p < 0.0001). Compared with colorectal procedures, patients undergoing pancreatic (OR 2.33, CI 1.40-3.87; p = 0.00108) and small intestine (OR 1.27; CI 1.12-1.44; p = 0.00015) surgery were more likely to develop S/SS. Patients undergoing biliary surgery (OR 0.38; CI 0.30-0.48; p < 0.0001) were less likely to develop S/SS. Risk factors for the development of sepsis or septic shock are ASA PS class 2 or higher, partially or totally dependent functional status, and male gender. Emergency pancreatic or small intestinal procedures may confer a higher risk. Greater vigilance and early post-operative screening may be of benefit in patients with these risk factors.
术后脓毒症比择期手术的死亡率更高，总住院费用增加 2.3 倍。本研究旨在确定接受急诊手术的患者术后发生脓毒症或感染性休克的危险因素。通过识别 2012 年至 2015 年期间接受急诊手术的患者，使用国家手术质量改进计划（NSQIP）进行回顾性队列分析，并比较发生术后脓毒症或感染性休克（S/SS）的患者与未发生的患者。排除术前脓毒症或感染性休克的患者。采用多因素逻辑回归分析非选择性手术患者发生 S/SS 的危险因素。在符合纳入标准的 122281 例患者中，2399 例（2%）发生 S/SS。S/SS 的危险因素为美国麻醉医师协会身体状况（ASA PS）分级 2 或更高（比值比 [OR] 2.57；95%置信区间 [CI] 2.19-3.02；p<0.0001）、完全依赖（OR 2.00，95%CI 1.38-2.83；p=0.00021）或部分依赖（OR 1.62，95%CI 1.35-2.00；p<0.0001）功能状态和男性（OR 1.31；95%CI 1.18-1.45；p<0.0001）。与结直肠手术相比，接受胰腺（OR 2.33，CI 1.40-3.87；p=0.00108）和小肠（OR 1.27；CI 1.12-1.44；p=0.00015）手术的患者更有可能发生 S/SS。接受胆道手术（OR 0.38；CI 0.30-0.48；p<0.0001）的患者发生 S/SS 的可能性较小。S/SS 发生的危险因素包括 ASA PS 分级 2 或更高、部分或完全依赖的功能状态和男性。急诊胰腺或小肠手术可能会带来更高的风险。对于具有这些危险因素的患者，更密切的监测和术后早期筛查可能会有所帮助。
