Medical College, Aga Khan University, Karachi, Pakistan; Research Fellow, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
Medical College, Aga Khan University, Karachi, Pakistan.
J Surg Res. 2024 Jun;298:160-168. doi: 10.1016/j.jss.2024.03.021. Epub 2024 Apr 17.
Postoperative sepsis represents a rare complication following thyroidectomy. We aimed to explore the incidence, risk factors, sources, and outcomes of postoperative sepsis and septic shock among adult patients undergoing thyroidectomy.
Data from the American College of Surgeons National Surgical Quality Improvement Program were used in this retrospective cohort study. Patients aged ≥18 y who underwent elective thyroidectomy between 2005 and 2019 were included. Multivariable binary logistic regression models were computed to explore risk factors and outcomes of 30-d sepsis and septic shock.
Among the 180,373 included patients, 0.1% developed sepsis or septic shock. Male gender, low body mass index, American Society of Anesthesiologists classes 3-5, functional dependence, smoking, diabetes mellitus, pulmonary disease, inpatient surgery, malignant indication, clean-contaminated wound classification, and operation time ≥150 min were significant risk factors for development of sepsis or septic shock. Common infectious sources of sepsis included surgical site infections (29.6%), pneumonia (18.6%), urinary tract infections (16.2%), and multiple infections (6.9%). Patients with postoperative sepsis or septic shock were significantly more likely to develop complications, including wound disruption, stroke, cardiac and renal complications, thromboembolism, prolonged length of stay, unplanned reoperation, and mortality.
Sepsis is rare following thyroidectomy. Our study provides insight into risk factors and procedural characteristics which may contribute to the development of postoperative sepsis or septic shock in this population.
甲状腺切除术后发生脓毒症是一种罕见的并发症。我们旨在探讨成年甲状腺切除术患者术后脓毒症和感染性休克的发生率、危险因素、来源和结局。
本回顾性队列研究使用了美国外科医师学会国家外科质量改进计划的数据。纳入了 2005 年至 2019 年间择期行甲状腺切除术且年龄≥18 岁的患者。采用多变量二项逻辑回归模型来探讨 30 天内脓毒症和感染性休克的危险因素和结局。
在纳入的 180373 例患者中，有 0.1%发生了脓毒症或感染性休克。男性、低体重指数、美国麻醉医师协会分级 3-5 级、功能依赖、吸烟、糖尿病、肺部疾病、住院手术、恶性指征、清洁污染伤口分类和手术时间≥150 分钟是发生脓毒症或感染性休克的显著危险因素。脓毒症的常见感染源包括手术部位感染（29.6%）、肺炎（18.6%）、尿路感染（16.2%）和多重感染（6.9%）。发生术后脓毒症或感染性休克的患者更有可能发生并发症，包括伤口裂开、中风、心脏和肾脏并发症、血栓栓塞、住院时间延长、非计划再次手术和死亡。
甲状腺切除术后发生脓毒症较为罕见。本研究深入了解了可能导致该人群术后发生脓毒症或感染性休克的危险因素和手术特点。
