Sepsis following cancer surgery: the need for early recognition and standardised clinical care

Hiong, Alison; Thursky, Karin; Teh, Benjamin W; Haeusler, Gabrielle M; Slavin, Monica A; Worth, Leon J

doi:10.1586/14787210.2016.1154787

Cited by 16 publications

(18 citation statements)

References 42 publications

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“…This is consistent with other publications in the literature . In fact, a significant body of literature reflects the increased risk of both sepsis and septic complications in the population studied here . Because delay in diagnosis of infective and septic complications contributes to increased mortality, early recognition is important in cancer patients with chronic immunosuppressant use.…”

Section: Discussionsupporting

confidence: 91%

Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity‐matched analysis

et al. 2018

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Aim Chronic immunosuppressant use increases the risk of septic complications after colectomy; however, adverse effects on other organ systems remain poorly understood. The aim of this study was to evaluate the multisystem organ effect(s) of chronic immunosuppressant(s) in colorectal cancer patients. Methods This was a retrospective study. The American College of Surgeons National Surgical Quality Improvement database (2005–2012) was queried. The primary end‐points were 30‐day mortality and 30‐day morbidity after colectomy in patients on chronic immunosuppressant(s) compared to a non‐immunosuppressant cohort. Results In total, 50 766 patients were identified, with 1203 (2.4%) taking chronic immunosuppressant(s). After propensity matching, 1197 patients in each cohort were evaluated with no differences seen in age, body mass index, male sex, wound classification, emergency case status, the presence of preoperative sepsis or operative time. On outcome analysis, 30‐day mortality (5.7% vs 3.4%, P < 0.001) and 30‐day overall morbidity (35.4% vs 29.0%, P = 0.001) were higher in patients on chronic immunosuppressant(s). Septic complications (10.6% vs 7.9%, P = 0.02) and surgical site infections (15.3% vs 12.3%, P = 0.03) were elevated with chronic immunosuppressant(s). There were no differences in cardiovascular, pulmonary, renal or neurological complications. Chronic immunosuppressant patients demonstrated longer total hospital stay (11.4 ± 11.7 vs 9.5 ± 9.4 days, P < 0.001) and postoperative length of stay (9.4 ± 9.2 vs 8.1 ± 7.6 days, P < 0.001). The limitation was that this was a retrospective study using a clinical dataset. Conclusion In this study, immunosuppressant use is associated with worsened infective complications, without contributing to organ‐specific complications following colectomy. Significant thought should be given to anastomosis vs stoma creation to possibly prevent worsened morbidity and mortality. Future study is required to determine specific pathways for risk reduction.

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Section: Discussionsupporting

confidence: 91%

Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity‐matched analysis

et al. 2018

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“…The importance of early recognition and intervention in sepsis is well‐established (Kumar et al, ; Moore & Moore, ; Rivers et al, ; Thursky & Worth, ; Yealy et al, ). Timely and standardised management reduces mortality (Burrell et al, ) and this is particularly important in cancer patients who are at increased risk of developing septic shock (Hiong et al, ). Identifying sepsis in the surgical setting is particularly challenging as sepsis may present with non‐specific findings, or be misclassified as a non‐infectious complication (Kaukonen et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The importance of early recognition and intervention in sepsis is well-established (Kumar et al, 2006;Moore & Moore, 2013;Rivers et al, 2001;Yealy et al, 2014). Timely and standardised management reduces mortality and this is particularly important in cancer patients who are at increased risk of developing septic shock (Hiong et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Initiation of the sepsis pathway does not guarantee full adherence to all evidence-based components of sepsis management (Hiong et al, 2016). However, on the basis of previously evaluated quality improvement programs, several core components of the pathway can be identified as minimum requirements for a sepsis management bundle.…”

Section: Number Of Infectionsmentioning

confidence: 99%

“…Sepsis is a significant complication of cancer management (Aquina et al, ; Avritscher et al, ; Mulvey et al, ), with severe sepsis estimated to account for 8.5% of all cancer deaths in the United States at a cost of $3.4 billion for the year of 2004 (Azoulay et al, ). Cancer patients are at increased risk of sepsis related to multiple factors (Mokart et al, ; Sood et al, ), including immunocompromise from underlying malignancy, immune dysfunction following chemotherapy, recurrent hospitalisation, and the requirement for interventions and invasive procedures that predispose to infection (Hiong et al, ). Survival of cancer patients admitted to intensive care units (ICUs) with sepsis has improved from approximately 20%–50% over recent decades (Azoulay et al, ; Jackson et al, ), this being ascribed largely to early recognition and treatment of sepsis and utilisation of standardised clinical pathways (Burrell, McLaws, Fullick, Sullivan, & Sindhusake, ).…”

Section: Introductionmentioning

confidence: 99%

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Impact of a hospital‐wide sepsis pathway on improved quality of care and clinical outcomes in surgical patients at a comprehensive cancer centre

et al. 2019

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Purpose Sepsis is a significant complication following cancer surgery. Although standardised care bundles improve sepsis outcomes in other populations, the benefits in cancer patients are unclear. The objectives of this study were to describe the epidemiology of sepsis in cancer patients post‐surgery, and to evaluate the impact of a clinical sepsis pathway on management and clinical outcomes. Methods A standardised hospital‐wide sepsis pathway was developed in 2013, and all cases of sepsis at the Peter MacCallum Cancer Centre in 2014 were retrospectively evaluated. Inclusion criteria were sepsis onset during the 100‐day period following a surgical procedure for cancer diagnosis. Patients were identified using ICD‐10‐AM sepsis discharge codes, audit documentation and the hospital’s antimicrobial approval system. Sepsis episodes were classified as managed on‐ or off‐pathway. Results A total of 119 sepsis episodes were identified. Of these, 71 (59.7%) were managed on the sepsis pathway. Episodes managed on‐pathway resulted more frequently in administration of appropriate antibiotics compared to those off‐pathway (94.4% vs. 66.7%, p < 0.001), and had shorter time to first‐dose antibiotics (median 85 vs. 315 min, p < 0.001). Pathway utilisation was associated with significant reductions in need for inotropes (7% vs. 13%, p = 0.023), ventilation (3% vs. 10%, p = 0.006) and length of hospitalisation (median 15 vs. 30 days, p = 0.008). The most frequent source of infection was organ‐space surgical site infection (24.4% of instances). Conclusions A dedicated hospital‐wide sepsis pathway had significant impact on the quality of care and clinical outcomes of sepsis in cancer surgery patients. Cost‐benefit analysis of sepsis pathways for cancer patients is required.

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Analyzing non‐cancer causes of death of colorectal carcinoma patients in the US population for the years 2000–2016

Zhang

et al. 2020

Cancer Medicine

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Background Colorectal cancer (CRC) treatment and patient survival improved greatly. Consequently an increased incidence of non‐cancer‐related deaths is observed. This study analyzed the causes of non‐cancer death for people suffering from CRC based on the year of diagnosis, follow‐up time, and patient's age. Methods The data from patients diagnosed with CRC in the years 2000–2016 were taken from the Surveillance, Epidemiology, and End Results 18 database. Patients were categorized according to: death from CRC, non‐CRC cancer, and non‐cancer. Constituent ratios and standardized mortality ratios (SMRs) were calculated to describe the death causes distribution and relative death risks. Results Between 2000 and 2016, a stable and rapid drop for the original diagnosis as death cause for CRC patients was observed (70.19% to 49.35%). This was coupled to an increase in non‐cancer‐associated death reasons (23.38% to 40.00%). The most common non‐cancer death cause was heart disease, especially for elderly patients. However, deaths from accidents and adverse effects were frequent in younger CRC patients. Patients died from septicemia more often within the first follow‐up year; however, a 6‐fold increase in death from Alzheimer's disease was found for after at least 180 months follow‐up time. The SMRs of all 25 non‐cancer death causes initially decreased in all CRC subgroups, followed by an increase with follow‐up times. Gradually decreasing SMR values were observed with increasing age of CRC patients. Conclusions These findings could help modify and sharpen preventive measures and clinical management and raise physician's awareness to potential non‐CRC death risk factors for CRC patients.

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Sepsis following cancer surgery: the need for early recognition and standardised clinical care

Cited by 16 publications

References 42 publications

Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity‐matched analysis

Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity‐matched analysis

Impact of a hospital‐wide sepsis pathway on improved quality of care and clinical outcomes in surgical patients at a comprehensive cancer centre

Analyzing non‐cancer causes of death of colorectal carcinoma patients in the US population for the years 2000–2016

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