Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Apr 22, 2024; 15(1): 92085
Published online Apr 22, 2024. doi: 10.4291/wjgp.v15.i1.92085
Sepsis during short bowel syndrome hospitalizations: Identifying trends, disparities, and clinical outcomes in the United States
Dushyant Singh Dahiya, Jennifer Wachala, Shantanu Solanki, Dhanshree Solanki, Asim Kichloo, Samantha Holcomb, Uvesh Mansuri, Khwaja Saad Haq, Hassam Ali, Manesh Kumar Gangwani, Yash R Shah, Teresa Varghese, Hafiz Muzaffar Akbar Khan, Simon Peter Horslen, Thomas D Schiano, Syed-Mohammed Jafri
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
Jennifer Wachala, Asim Kichloo, Samantha Holcomb, Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
Shantanu Solanki, Division of Gastroenterology Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Dhanshree Solanki, Department of Medicine, Institute for Foreign Medical Graduate Education, Houston, TX 77030, United States
Uvesh Mansuri, Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, MD 21225, United States
Khwaja Saad Haq, Teresa Varghese, Department of Internal Medicine, WellStar Spalding Regional Hospital, Griffin, GA 30224, United States
Hassam Ali, Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
Manesh Kumar Gangwani, Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Yash R Shah, Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
Hafiz Muzaffar Akbar Khan, Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Simon Peter Horslen, Department of Pediatrics, School of Medicine and UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15219, United States
Thomas D Schiano, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Syed-Mohammed Jafri, Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI 48202, United States
Author contributions: Dahiya DS, Wachala J, Solanki S, and Jafri SM contributed to the conception and design; Dahiya DS, Solanki S, Kichloo A, and Jafri SM contributed to the administrative support; Dahiya DS, Wachala J, Solanki S, Solanki D, Kichloo A, Holcomb S, Mansuri U, Haq KS, Ali H, Gangwani MK, and Shah YR contributed to the provision, collection, and assembly of data; Dahiya DS, Wachala J, Solanki S, Solanki D, Kichloo A, Holcomb S, Mansuri U, Haq KS, Ali H, Gangwani MK, Shah YR, Varghese T, Khan HMA, Horslen S, Schiano TD, and Jafri SM contributed to the review of literature and drafting the manuscript; Dahiya DS, Wachala J, Solanki S, Solanki D, Kichloo A, Holcomb S, Mansuri U, Haq KS, Ali H, Gangwani MK, Shah YR, Varghese T, Khan HMA, Horslen S, Schiano TD, and Jafri SM contributed to the revision of key components of the manuscript and final approval of manuscript; Dahiya DS, Wachala J, Solanki S, Solanki D, Kichloo A, Holcomb S, Mansuri U, Haq KS, Ali H, Gangwani MK, Shah YR, Varghese T, Khan HMA, Horslen S, Schiano TD, and Jafri SM are accountable for all aspects of the work.
Institutional review board statement: The National Inpatient Sample lacks specific patient and hospital identifiers. Hence, our analysis did not require institutional review board (IRB) approval as per guidelines put forth by our institutional IRB for the analysis of national databases.
Informed consent statement: The National Inpatient Sample lacks specific patient identifiers. Hence, informed consent was not required.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Data sharing statement: The National Inpatient Sample (NIS) is a large, publicly available, all-payer inpatient care database in the United States containing data on millions of hospital stays per year. The large sample size derived from the NIS database provides sufficient data for analysis of common diseases, uncommon disorders, and procedures. The NIS is publicly available at: https://www.hcup-us.ahrq.gov/
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, 2000 Olathe Blvd, Kansas City, KS 66160, United States. dush.dahiya@gmail.com
Received: January 15, 2024
Peer-review started: January 15, 2024
First decision: February 3, 2024
Revised: February 10, 2024
Accepted: March 25, 2024
Article in press: March 25, 2024
Published online: April 22, 2024
Processing time: 94 Days and 10.4 Hours
Abstract
BACKGROUND

Short bowel syndrome (SBS) hospitalizations are often complicated with sepsis. There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe.

AIM

To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States.

METHODS

The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014. The study cohort was further divided based on the presence or absence of sepsis. Trends were identified, and hospitalization characteristics and clinical outcomes were compared. Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed.

RESULTS

Of 247097 SBS hospitalizations, 21.7% were complicated by sepsis. Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8% in 2005 to 23.5% in 2014 (P trend < 0.0001). Compared to non-septic SBS hospitalizations, septic SBS hospitalizations had a higher proportion of males (32.8% vs 29.3%, P < 0.0001), patients in the 35-49 (45.9% vs 42.5%, P < 0.0001) and 50-64 (32.1% vs 31.1%, P < 0.0001) age groups, and ethnic minorities, i.e., Blacks (12.4% vs 11.3%, P < 0.0001) and Hispanics (6.7% vs 5.5%, P < 0.0001). Furthermore, septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation (0.33% vs 0.22%, P < 0.0001), inpatient mortality (8.5% vs 1.4%, P < 0.0001), and mean length of stay (16.1 d vs 7.7 d, P < 0.0001) compared to the non-sepsis cohort. A younger age, female gender, White race, and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations.

CONCLUSION

Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

Keywords: Short bowel syndrome; Sepsis; Outcomes; Mortality; Trends

Core Tip: Short bowel syndrome (SBS) is a well-known complication of small bowel surgical resection. Sepsis is a well-documented complication of SBS, particularly in infants and children. However, there is limited data on adult SBS hospitalizations complicated by sepsis in the United States. In this study, we noted that about one-fifth of SBS hospitalizations were complicated by sepsis. There was a higher proportion of men, individuals in the 35-64 age group, and ethnic minorities (Blacks and Hispanics) in the septic SBS cohort compared to the non-sepsis cohort. Septic SBS hospitalizations also had a higher length of stay and inpatient mortality compared to the non-sepsis cohort. Furthermore, younger age, female gender, White race, anemia, and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations.