Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery

Bouza, Carmen; Ortíz, Cristina; Amate-Blanco, J. M.

doi:10.1002/bjs.10065

Cited by 10 publications

(13 citation statements)

References 31 publications

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“…Organ system dysfunction was analyzed for all patients and age groups, and cardiovascular and hematological system dysfunctions were associated with the highest likelihood of developing postoperative sepsis. Organ system dysfunction was also associated with increased risk of sepsis [13]. These findings supported the findings of other studies that cardiovascular and hema-tological systems play major roles in the development of postoperative sepsis.…”

Section: Table 1 Continued: Basic Characteristics Of the Study Particsupporting

confidence: 89%

“…Individuals who were not hospitalized, under 18 years of age, or had sepsis before surgery were also excluded. Using ICD-9-CM codes, we identified patients according to category of surgical procedure, and both hospitalized patients and surgical diagnosis-related groups (DRGs) were selected [9,[11][12][13]. The sepsis population was identified by secondary diagnoses using ICD-9-CM codes, namely 038, 038.0, 038.1, 038.2, 038.3, 038.4, 038.8, 038.9, 038.…”

Section: Study Population Selection and Definitionsmentioning

confidence: 99%

“…Although many studies have validated the use of this administrative data [11,13], the data were originally intended for claims reimbursements and thus lack detailed biochemical data for each individual. Moreover, a statistical bias attributable to the coding schemes related to the limitations of various clinical entities cannot be entirely excluded; for example, they may have failed to accurately differentiate comorbidities from chronic diseases and organ system dysfunctions [11,13,15]. Some comorbidities or organ system dysfunctions may have been missed because only five diagnostic ICD-9-CM codes were assessed, which may have resulted in an underestimation of the incidence.…”

Section: Limitations Of the Studymentioning

confidence: 99%

“…Organ system dysfunctions included acute renal disease (ICD-9-CM: 584, 580, 39.95) and dysfunction of the respiratory (ICD-9-CM: 518.81-518.85, 786.09, 799.1, 96.7), cardiovascular (ICD-9-CM: 785.5, 458, 796.3), hepatic (ICD-9-CM: 570, 572.2, 573.3), hematological (ICD-9-CM: 286.6, 286.9, 287.3-287.5), and metabolic (ICD-9-CM: 276.2) systems[11,13].…”

mentioning

confidence: 99%

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Epidemiological characteristics of postoperative sepsis

Chen

Luo

Chen³

et al. 2019

Open Medicine

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AbstractBackgroundPostoperative sepsis is a major type of sepsis. Sociodemographic characteristics, incidence trends, surgical procedures, comorbidities, and organ system dysfunctions related to the disease burden of postoperative sepsis episodes are unclear.MethodsWe analyzed epidemiological characteristics of postoperative sepsis based on the ICD-9-CM codes for the years 2002 to 2013 using the Longitudinal Health Insurance Databases of Taiwan’s National Health Insurance Research Database.ResultsWe identified 5,221 patients with postoperative sepsis and 338,279 patients without postoperative sepsis. The incidence of postoperative sepsis increased annually with a crude mean of 0.06% for patients aged 45–64 and 0.34% over 65 years. Patients with postoperative sepsis indicated a high risk associated with the characteristics, male sex (OR:1.375), aged 45–64 or ≥ 65 years (OR:2.639 and 5.862), low income (OR:1.390), aged township (OR:1.269), agricultural town (OR:1.266), and remote township (OR:1.205). Splenic surgery (OR:7.723), Chronic renal disease (OR:1.733), cardiovascular dysfunction (OR:2.441), and organ system dysfunctions had the highest risk of postoperative sepsis.ConclusionRisk of postoperative sepsis was highest among men, older, and low income. Patients with splenic surgery, chronic renal comorbidity, and cardiovascular system dysfunction exhibited the highest risk for postoperative sepsis. The evaluation of high-risk factors assists in reducing the disease burden.

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Section: Table 1 Continued: Basic Characteristics Of the Study Particsupporting

confidence: 89%

Section: Study Population Selection and Definitionsmentioning

confidence: 99%

Section: Limitations Of the Studymentioning

confidence: 99%

mentioning

confidence: 99%

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Epidemiological characteristics of postoperative sepsis

Chen

Luo

Chen³

et al. 2019

Open Medicine

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“…Clinical outcomes affect both the institution and the patient. This includes the avoidance of sepsis, which given its mortality implications in an ageing population and concerns over antibiotic resistance is of increasing importance in the surgical patient [21]. …”

Section: Discussionmentioning

confidence: 99%

Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis

2016

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BackgroundSurgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2 conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis.MethodsA retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre. The control group (n = 123) received peritoneal insufflation with room temperature, dry CO2, whereas the intervention group (n = 123) received warm, humidified CO2 (using HumiGard™, Fisher & Paykel Healthcare). The outcomes were postoperative hypothermia, SSI and costs. Multivariate analysis was performed.ResultsA total of 246 patients were included in the study. The mean age was 68 (20–87) and mean BMI 28 (15–51). The primary diagnosis was cancer (n = 173), and there were no baseline differences between the groups. CO2 conditioning significantly decreased the incidence of postoperative hypothermia (odds ratio 0.10, 95 % CI 0.04–0.23), with hypothermic patients found to be at increased risk of SSI (odds ratio 4.0, 95 % CI 1.25–12.9). Use of conditioned CO2 significantly decreased the incidence of SSI by 66 % (p = 0.04). The intervention group incurred costs of £155 less per patient. The incremental cost-effectiveness ratio was negative.Conclusion CO2 conditioning during laparoscopic colorectal surgery is a safe, feasible and a cost-effective intervention. It improves the quality of surgical care relating to SSI and postoperative hypothermia.

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Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case–control study

Attard

Al-Sarireh

Bhogal

et al. 2021

British Journal of Surgery

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Background Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. Methods This was a multicentre retrospective case–control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. Results In total, 235 octogenarians (median age 81 (range 80–90) years) and 235 controls (age 67 (31–79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0–3) versus 0 (0–2); P = 0.010) and Charlson Co-morbidity Index score (7 (6–11) versus 5 (2–9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. Conclusion Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.

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Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery

Cited by 10 publications

References 31 publications

Epidemiological characteristics of postoperative sepsis

Epidemiological characteristics of postoperative sepsis

Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis

Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case–control study

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