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
ARTICLE HIGHLIGHTS
Research background

Gastrointestinal perforation (GIP) is a common acute abdominal injury. It usually requires active rescue in the intensive care unit with an emergency laparotomy. The definition of sepsis was revised in 2016 (sepsis 3.0) to better reflect the prognosis and organ function damage rather than being defined as infection-induced systemic inflammatory response syndrome. Once sepsis occurs, the prognosis worsens, and few studies have focused on the risk factors for postoperative sepsis in patients with GIP.

Research motivation

In 2016, the definition of sepsis was revised. According to the revision, patients with postoperative sepsis would be at a higher risk for death. As a result, we thought an investigation of the risk factors for postoperative sepsis was very necessary.

Research objectives

This study aimed to investigate the risk factors for postoperative sepsis in patients with GIP.

Research methods

From January 2016 to December 2018, the medical records of patients with GIP, receiving emergency surgery, were retrospectively reviewed and analyzed. Risk factors for postoperative sepsis in patients with GIP were evaluated.

Research results

A total of 212 patients were eligible. The prevalence of postoperative sepsis was 22.6% [95% confidence interval (CI): 17.0%-28.3%, n = 48]. 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), diameter of perforation (OR = 1.062, 95%CI: 1.007-1.121, P = 0.027), and the incidence of malignant tumor-related perforation (OR = 5.384, 95%CI: 1.762-32.844, P = 0.021) were associated with postoperative sepsis.

Research conclusions

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.

Research perspectives

A further study plans to include more subjects and the development of a prediction model for postoperative sepsis, in order to identify a truly accurate diagnostic method suitable for clinical use.