Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 670-678
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.670
Risk factors for postoperative sepsis in patients with gastrointestinal perforation
Xin Xu, Hai-Chang Dong, Zheng Yao, Yun-Zhao Zhao
Xin Xu, Zheng Yao, Yun-Zhao Zhao, Department of General Surgery, Jiangning Hospital, Nanjing 210002, Jiangsu Province, China
Hai-Chang Dong, Department of General Surgery, Huaihe Hospital, Kaifeng 475000, Henan Province, China
Author contributions: All authors contributed equally to conception and design of the study, literature review and analysis, manuscript drafting, critical revision, editing, and approval of the final version.
Institutional review board statement: The study was reviewed and approved by the Huaihe Hospital, Henan University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dr_yaozheng@163.com
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
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: http://creativecommons.org/licenses/by-nc/4.0/
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zheng Yao, MD, Department of General Surgery, Jiangning Hospital, Hushan Road 169, Nanjing 210002, Jiangsu Province, China. dr_yaozheng@163.com
Received: December 3, 2019
Peer-review started: December 3, 2019
First decision: December 23, 2019
Revised: February 4, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: February 26, 2020
Processing time: 85 Days and 7.3 Hours
Abstract
BACKGROUND

Sepsis is fatal in patients with gastrointestinal perforation (GIP). However, few studies have focused on this issue.

AIM

To investigate the risk factors for postoperative sepsis in patients with GIP.

METHODS

This was a retrospective study performed at the Department of General Surgery in our treatment center. From January 2016 to December 2018, the medical records of patients with GIP who underwent emergency surgery were reviewed. Patients younger than 17 years or who did not undergo surgical treatment were excluded. The patients were divided into the postoperative sepsis group and the non-postoperative sepsis group. Clinical data for both groups were collected and compared, and the risk factors for postoperative sepsis were investigated. The institutional ethical committee of our hospital approved the study.

RESULTS

Two hundred twenty-six patients were admitted to our department with GIP. Fourteen patients were excluded: Four were under 17 years old, and 10 did not undergo emergency surgery due to high surgical risk and/or disagreement with the patients and their family members. Two hundred twelve patients were finally enrolled in the study; 161 were men, and 51 were women. The average age was 62.98 ± 15.65 years. Postoperative sepsis occurred in 48 cases. The prevalence of postoperative sepsis was 22.6% [95% confidence interval (CI): 17.0%-28.3%]. Twenty-eight patients (13.21%) died after emergency surgery. Multiple logistic regression analysis confirmed that the time interval from abdominal pain to emergency surgery [odds ratio (OR) = 1.021, 95%CI: 1.005-1.038, P = 0.006], colonic perforation (OR = 2.761, CI: 1.821–14.776, P = 0.007), perforation diameter (OR = 1.062, 95%CI: 1.007-1.121, P = 0.027), and incidence of malignant tumor-related perforation (OR = 5.384, 95%CI: 1.762-32.844, P = 0.021) were associated with postoperative sepsis.

CONCLUSION

The time interval from abdominal pain to surgery, colonic perforation, diameter of perforation, and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.

Keywords: Risk factor; Sepsis; Gastrointestinal perforation; Prevalence; Postoperative period

Core tip: Postoperative sepsis is fatal in patients with gastrointestinal perforation (GIP). The definition of sepsis was revised in 2016. Few studies have focused on the risk factors for postoperative sepsis (revision 2016). In this study, the medical records of patients with GIP who underwent emergency surgery from January 2016 to December 2018 were reviewed. It was found that the time interval from abdominal pain to emergency surgery, colonic perforation, diameter of perforation, and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.