Abstract
ObjectivesSepsis and septic shock are important quality and patient safety metrics. This study examines incidence of Sepsis and/or septic shock (S/SS) after craniotomy for tumor resection, one of the most common neurosurgical operations.MethodsMulticenter, prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify patients undergoing craniotomy for tumor (CPT 61510, 61521, 61520, 61518, 61526, 61545, 61546, 61512, 61519, 61575) from 2012–2015. Univariate and multivariate logistic regression models were used to identify risk factors for S/SS.ResultsThere were 18,642 patients that underwent craniotomy for tumor resection. The rate of sepsis was 1.35% with a mortality rate of 11.16% and the rate of septic shock was 0.65% with a 33.06% mortality rate versus an overall mortality rate of 2.46% in the craniotomy for tumor cohort. The 30-day readmission rate was 50.54% with S/SS vs 10.26% in those without S/SS. Multiple factors were identified as statistically significant (p <0.05) for S/SS including ascites (OR = 33.0), ventilator dependence (OR = 4.5), SIRS (OR = 2.8), functional status (OR = 2.3), bleeding disorders (OR = 1.7), severe COPD (OR = 1.6), steroid use (OR = 1.6), operative time >310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), ASA class ≥ 3 (OR = 1.4), male sex (OR = 1.4), BMI >35 (OR = 1.4) and infratentorial location.ConclusionsThe data indicate that sepsis and septic shock, although uncommon after craniotomy for tumor resection, carry a significant risk of 30-day unplanned reoperation (35.60%) and mortality (18.21%). The most significant risk factors are ventilator dependence, ascites, SIRS and poor functional status. By identifying the risk factors for S/SS, neurosurgeons can potentially improve outcomes. Further investigation should focus on the creation of a predictive score for S/SS with integration into the electronic health record for targeted protocol initiation in this unique neurosurgical patient population.
Highlights
Multiple factors were identified as statistically significant (p 310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), American Society of Anesthesiologists (ASA) class 3 (OR = 1.4), male sex (OR = 1.4), body mass index (BMI) >35 (OR = 1.4) and infratentorial location
According to the Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) in 2016, sepsis was defined as multiple organ dysfunction caused by infection, and septic shock was defined as a subset of sepsis in which underlying syndromes of complex biochemical, pathological, and physiological alterations are significant enough to add the risk of mortality [1]
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a validated prospectively collected, publicly available, peer-controlled database of a random sample of inpatients and outpatients undergoing non-trauma surgery in Associated factors for sepsis and septic shock after craniotomy approximately 400 academic and community hospitals across the United States
Summary
According to the Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) in 2016, sepsis was defined as multiple organ dysfunction caused by infection, and septic shock was defined as a subset of sepsis in which underlying syndromes of complex biochemical, pathological, and physiological alterations are significant enough to add the risk of mortality [1]. Both sepsis and septic shock have a profound impact on patient morbidity and mortality [2]. The Centers for Disease Control (CDC) and the Agency for Healthcare Research and Quality (AHRQ), as part of the National Quality Forum, have identified postoperative sepsis as an important contributor to the Patient Safety Adverse Events Composite, or PSI 90 score, which is used to formulate hospital ratings [7]
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