Risk factors for postoperative sepsis in patients with gastrointestinal perforation

Table 1 The characteristics of the 212 patients with gastrointestinal perforation and univariate analysis for postoperative sepsis

Clinical variables	Enrolled patients (n = 212)	Univariate analysis
		Postoperative sepsis group (n = 48)	Non-postoperative sepsis group (n = 164)	P value
Age, (yr; mean ± SD)	62.98 ± 15.65	72.58 ± 14.89	60.17 ± 14.77	< 0.001
Female, n (%)	51 (24.06)	16 (33.33)	35 (21.34)	0.123
BMI (kg/m2; mean ± SD)	22.40 ± 2.95	22.10 ± 2.67	22.48 ± 3.02	0.441
Temperature [°C, mean (IQR)]	36.75 (36.50-37.00)	36.80 (36.63-38.80)	36.65 (36.50-37.00)	0.001
Heart rate [beats/min, mean (IQR)]	80 (77-88)	87 (80-99)	80 (78-84)	< 0.001
Mean arterial pressure (mmHg; mean ± SD)	90.75 ± 13.80	84.97 ± 12.11	92.45 ± 13.84	0.001
Breathing rate [times/min, mean (IQR)]	20 (19-21)	20 (20-22)	20 (10-21)	0.12
Hemoglobin (g/L, mean ± SD)	135.33 ± 19.85	130.73 ± 19.32	136.67 ± 19.86	0.068
Serum creatinine (μmol/L, mean ± SD)	84.38 ± 49.89	106.38 ± 79.37	77.94 ± 40.12	< 0.001
Total bilirubin (μmol/L, mean ± SD)	15.99 ± 12.36	13.75 ± 6.48	16.65 ± 13.56	0.152
White blood cells (× 109/L) [mean (IQR)]	10.74 (7.20-15.00)	7.50 (4.48-13.21)	11.42 (7.83-15.20)	0.003
C-reactive protein (mg/L, mean ± SD)	128.67 ± 77.42	157.08 ± 77.26	120.35 ± 75.70	0.004
Preoperative ASA score [mean (IQR)]	2 (1-3)	3 (2-4)	2 (1-2)	< 0.001
Ascites, n (%)	156 (73.58)	48 (100)	108 (65.85)	< 0.001
Diameter of perforation, (mm, mean ± SD)	12.69 ± 10.63	15.93 ± 10.11	11.75 ± 10.61	0.015
Time interval from abdominal pain to emergency surgery (h, mean ± SD)	23.49 ± 35.63	42.21 ± 44.62	18.01 ± 30.59	0.001
Operation duration, [h, mean (IQR)]	2 (1.5-2.5)	2 (15-3)	2 (1.3-2)	0.061
Anatomy of GIP, n (%)
Stomach	118 (55.66)	12 (25)	106 (64.63)	0.001
Duodenum	33 (15.57)	10 (20.83)	23 (14.02)	0.262
Jejunum/Ileum	19 (8.96)	6 (12.5)	13 (7.93)	0.388
Colon	42 (19.81)	16 (33.33)	26 (20.12)	0.008
Etiology, n (%)
Trauma	80 (37.74)	18 (37.5)	62 (37.80)	1.000
Malignant tumor	30 (14.15)	14 (29.17)	16 (9.76)	0.002
Benign ulcer	102 (48.11)	16 (33.33)	86 (52.44)	0.220
Surgical procedure, n (%)
Repair	169 (79.71)	30 (62.5)	139 (84.76)	0.002
Repair + Ostomy1	11 (5.19)	3 (6.25)	8 (4.88)	0.751
Resection and anastomosis2	6 (2.83)	2 (4.17)	4 (2.44)	0.623
Resection + ostomy3	12 (5.66)	4 (8.33)	8 (4.88)	0.451
Digestive tract reconstruction4	14 (6.60)	9 (18.75)	5 (3.05)	0.001
Laparoscopic surgery, n (%)	71 (33.50)	19 (39.58)	52 (31.71)	0.385
Co-morbidities, n (%)
Hypertension	33 (15.57)	6 (12.5)	27 (16.46)	0.652
Diabetes mellitus	19 (8.96)	7 (14.58)	12 (7.32)	0.149
Coronary disease	27 (12.74)	6 (12.5)	21 (12.81)	1.000
Sepsis, n (%)	48 (23.11)	N/A	N/A	N/A

¹Eleven patients received a repair + ostomy (colon repair + enterostomy), due to trauma-related colonic perforation.

²Two patients with a jejunal/ileal perforation, and 4 with a gastric tumor received tumor resection.

³Twelve patients with a colonic malignant perforation received resection + ostomy (9 patients with partial colectomy + colostomy, 3 patients with colectomy and anastomosis + enterostomy).

⁴Fourteen patients received a subtotal gastrectomy + gastrojejunostomy, due to gastric cancer. ASA score: American Society of Anesthesiologists score; BMI: Body mass index; GIP: Gastrointestinal perforation; SD: Standard deviation; IQR: Interquartile range. P < 0.001, vs the non-postoperative sepsis group.

Table 2 Emergency surgical procedures

Emergency surgical procedure	Location of the perforation	n (%)
Laparoscopic surgery
Laparoscopic gastric repair	Stomach1	52 (24.52)
Laparoscopic duodenal repair	Duodenum	10 (4.72)
Laparoscopic jejunal/ileal repair	Jejunum/Ileum	9 (4.25)
Open abdominal surgery
Repair
Gastric repair	Stomach1	48 (22.64)
Duodenal repair	Duodenum	23 (10.85)
Jejunal/ileal repair	Jejunum/Ileum	8 (3.77)
Colonic repair	Colon2	19 (8.96)
Repair + ostomy
Colonic repair + enterostomy	Colon2	11 (5.019)
Resection and anastomosis
Partial gastrectomy	Stomach3	4 (1.87)
Jejunal/ileal resection and anastomosis	Jejunum/Ileum	2(0.94)
Resection + ostomy
Partial colectomy + colostomy	Colon4	9 (4.24)
Partial colectomy and anastomosis + enterostomy	Colon4	3 (1.42)
Digestive tract reconstruction
Subtotal gastrectomy + gastrojejunostomy	Stomach3	14 (6.60)

¹Non-tumor-related gastric perforation.

²Non-tumor-related colonic perforation.

³Malignant tumor-related gastric perforation.

⁴Malignant tumor-related colonic perforation.

Table 3 Risk factors for postoperative sepsis in patients with gastrointestinal perforation

Clinical variables	OR	95%CI	P value
Age	1.019	0.966-1.042	0.234
Temperature	2.160	0.998-4.147	0.053
Heart rate	1.047	0.996-1.104	0.071
Mean arterial pressure	0.946	0.349-1.108	0.171
Serum creatinine	0.997	0.987-1.006	0.527
White blood cells	1.037	0.938-1.147	0.479
C-reactive protein	1.006	0.997-1.014	0.245
Ascites	1.316	0.102-14.982	0.996
Diameter of perforation	1.062	1.007-1.121	0.027
Gastric perforation	0.897	0.854-1.175	0.089
Colonic perforation	2.761	1.821-14.776	0.007
Preoperative ASA score	1.273	0.637-2.542	0.494
Time interval from abdominal pain to emergency surgery	1.021	1.055-1.038	0.006
Repair of perforation	0.961	0.247-3.739	0.954
Digestive tract reconstruction1	6.460	0.907-46.007	0.063
Malignant tumor-related perforation	5.384	1.762-32.844	0.021

¹Subtotal gastrectomy + gastrojejunostomy. ASA score: American Society of Anesthesiologists score; GIP: Gastrointestinal perforation; OR: Odds ratio; CI: Confidence interval.

Table 4 Prognosis of patients

Clinical variables	Postoperative sepsis group	Non-postoperative sepsis group	P value
Death, n (%)	24 (50)	4 (2.44)	< 0.001
Septic shock	22 (45.83)	0 (0)	< 0.001
Pulmonary embolism	0 (0)	3 (1.83)	1.000
Heart failure	2 (4.17%)	1 (0.610%)	0.129
LOS of survivors (mean ± SD, d)	20.96 ± 4.97	11.69 ± 2.8	< 0.001

LOS: Length of stay. P < 0.001, vs the non-postoperative sepsis group.