Postsurgical Sepsis Research Articles

Transforming in-clinic post-operative and intermediate care with cosinuss°

Continuous, mobile patient monitoring plays a critical role in healthcare, particularly for post-surgery, intermediate care in clinics. The implementation of vital signs monitoring technology enables healthcare professionals to triage patients effectively by maintaining real-time awareness of their health status and allowing for prompt intervention when necessary. This technology supports early mobilization and facilitates the detection of potential complications such as post-surgical sepsis. cosinuss° technology has been evaluated in various studies, in terms of its accuracy in capturing vital parameters and its usability, emphasizing its potential to enhance intermediate patient care and outcomes. This report outlines the design and implementation of cosinuss° Health patient monitoring solution for use in intermediate, postoperative clinic settings. It presents the results and insights from three recent, in-clinic applications, discussing both technical and practical aspects, clinical processes, and the reported satisfaction from both patients and medical caregivers. The findings highlight the promising potential of cosinuss° Health on improving patient monitoring and overall clinical outcomes.

Optimization and Early Detection of Postsurgical Sepsis and Surgical Site Infection

Optimization and Early Detection of Postsurgical Sepsis and Surgical Site Infection

Risk-Benefit Comparison Between Endoloop and Endostapler Devices for the Closure of Appendiceal Stumps in Laparoscopic Appendectomy.

Introduction Acute appendicitis is a common cause of acute abdomen and the most frequent surgical emergency in the world. Since the nineteenth century, surgical resolution has been the most accepted treatment worldwide, and laparoscopic appendectomy is currently preferred as the treatment of choice because it has several benefits. The closure of the appendiceal stump is the most crucial step during appendectomy since its inadequate management can cause post-surgical complications. Throughout recent years, several methods have been proposed to perform this closure. This study was performed to compare the post-surgical outcomes of the use of endoloop and endostapler devices. Methods This is a retrospective study of 290 patients aged 18 to 83 who underwent laparoscopic appendectomy between 2016 and 2020. Demographic data, clinical history, tomographic findings, and laboratory data were collected, as well as appendicular base management technique, severity degree of appendicitis at hospital admission, postoperative complications at 30 days, hospital readmission, and in-hospital stay. Statistical tests and binary logistic regression analyses were used to identify risk factors, with a significance level of p<0.05. Results Demographic data and clinical history did not show statistically significant differences. The presence of a pre-surgical abscess with tomography was 1.58 times higher in the endostapler group. Post-surgical results showed that the use of endostapler devices represented a 2.7 times higher risk of post-surgical abscess. The endostapler group was also found to have 1.87 times the risk of post-surgical sepsis. Conclusion Our study shows that the use of an endoloop reduces the risk of postoperative abscess by 16.5% and protects against the development of post-surgical sepsis by 30%.

Association of preoperative electrocardiographic markers with sepsis in elderly patients after general surgery

BackgroundElectrocardiographic markers, as surrogates for sympathetic excitotoxicity, are widely predictive of cardiovascular adverse events, but whether these markers can predict postsurgical sepsis (SS) is unclear.MethodsWe retrospectively analyzed patients who underwent abdominal surgery from March 2013 to May 2023. We collected basic data, comorbidities, blood samples, echocardiology, electrocardiogram, and surgical data, as well as short-term outcome. The primary endpoints were postsurgical SS, in which logistic regression analyses can identify independent risk factors. The optimal cut-off value predictive postsurgical SS both P wave and PR interval were calculated in the receiver operating characteristic curve (ROC).ResultsA total of 1988 subjects were analyzed, and the incidence of postsurgical SS was 3.8%. The mean age at enrollment was 68.6 ± 7.1 years, and 53.2% of the participants were men. In the ROC analysis, the areas under the curve (AUC) for P wave and PR interval predictive postsurgical SS were 0.615 (95%CI, 0.548–0.683; p = 0.001) and 0.618 (95%CI, 0.554–0.682; p = 0.001), respectively. The P wave and PR interval predicted postoperative sepsis with optimal discrimination of 103 and 157 ms, with a sensitivity of 0.744 and 0.419, and a specificity of 0.427 and 0.760. P-wave less than 103 ms or PR interval less than 157 ms associated with a 2.06 or 2.33 fold increase occurred risk postsurgical SS.ConclusionsShorter P-wave and PR intervals were both independently associated with postsurgical SS. These preoperative electrophysiological markers could have potential useful for early recognition of postoperative SS.

Procalcitonin Biomarker for Sepsis in Postoperative Pediatric Trauma Patients: Three Years of Experience from a Tertiary University Hospital.

The biomarker procalcitonin (PCT) is good in detecting sepsis in postoperative pediatric trauma patients, especially those with a high suspicion of sepsis, and formulating a quick treatment. Its use is still limited to pediatric surgical patients, particularly those in intensive care units (ICUs), who are more susceptible to sepsis. The purpose of this study was to see if procalcitonin could be used as a reliable and quick biomarker for sepsis in postoperative pediatric trauma patients and were brought to the PICU. This retrospective longitudinal study was conducted from January 2017 to December 2019. Postoperative pediatric trauma patients aged > 2 weeks old who were hospitalized at the PICU of King Fahd Hospital of the University due to serious trauma or post-acute surgical events were included. Within 24 hours of admission, PCT levels were measured, and again 48-72 hours later. In our study, 31% of severely ill children developed post-surgical sepsis. When compared to the PRISM III score and 24-hour PCT level, PCT levels at 48-72 hours exhibited the largest area under the curve (AUC). With a sensitivity of 71% and a specificity of 65%, the predictive AUC value was estimated to be 0.71. The AUC of PCT levels at 48-72 hours was 0.72 (95% confidence interval (CI): 0.65-0.79; p < 0.001), indicating high predictive validity using a cutoff point > 0.10, with sensitivity, specificity, and positive and negative predictive values of 68.4%, 63.6%, 45.8%, and 81.8%, respectively. PCT is a sensitive biomarker for detecting sepsis in postoperative pediatric trauma patients, especially those with a high pre-test suspicion for sepsis. In addition, PCT can be used alone or in combination with other clinical findings to help formulate a rapid primary diagnosis of sepsis in this subset of patients.

Early Identification of Postsurgical Sepsis and Surgical Site Infection

One of the most typical sources of hospital infection is surgical site infection. The term "Surgical Site Infection", which is separated into "Wound infections" and "organ or space infections," was coined by the Centers for Disease Control to describe the issue of postoperative infections. The organization also created the criteria that identify this type of infection. It might be difficult to recognize the problem early and to start evidence-based treatments quickly. The prognosis of these individuals can be considerably improved by early discovery, protocolized therapy based on the first bundle, prompt control of the septic focus, and the use of adjuvant therapies.

Early Identification of Postsurgical Sepsis and Surgical Site Infection

Early Identification of Postsurgical Sepsis and Surgical Site Infection

Malignant Bowel Obstruction in Ovarian Cancer Recurrence: The Role of Palliative Surgery in a Decision-Making Process

Background: Malignant bowel obstruction (MBO) is often the latest stage in ovarian cancer (OC). The therapy of this condition ranges from medical waiting to surgery. The objective of this pilot study is to compare the two strategies so that we can provide a path forward for future studies. Methods: From 700 women diagnosed with OC in the database of the Division of Gynecologic Oncology we crossed the names of those admitted by the emergency services of the IRCSS Azienda Ospedaliero Universitaria of Bologna, Italy. We selected MBO patients with a history of OC as the only neoplastic condition and compared the results between medical conduct and surgery to restore intestinal transit. Results: Of the 700 women in our database, 36 were eligible for study according to the inclusion and exclusion criteria: 9 in surgery group and 27 in medical group. Surgical conduct (tumor biopsy and stoma) appears to be resolutory for the obstruction and have a better result than medical therapy regarding recurrence of MBO, despite the development of greater complications. Relapses of MBOs occurred in 11% of surgical patients and 44% of medical patients (p = 0.0714). Furthermore, after surgical treatment, five patients (55%) experienced postoperative complications; in four cases, severe anemia requiring blood transfusion, while one patient developed post-surgical sepsis, which evolved into multiple organ failure and death. Of the 9 patients treated surgically, 2 (22%) were given surgery as a first choice. In most cases (78%), surgery was decided upon when medical treatment failed. The only discriminative factor appears to be age. The length of hospitalization increased with the patient’s age (p = 0.0181) as statistically significant factors for a worse outcome in surgery. Conclusions: MBO requires complex and multidisciplinary management where different factors need to be considered before initiating surgical therapy. Future studies are needed to deal with this complex problem.

Association of hospital nursing and postsurgical sepsis.

Despite concerted research and clinical efforts, sepsis remains a common, costly, and often fatal occurrence. Little evidence exists for the relationship between institutional nursing resources and the incidence and outcomes of sepsis after surgery. The objective of this study was to examine whether hospital nursing resource quality is associated with postsurgical sepsis incidence and survival. This cross-sectional, secondary data analysis used registered nurses’ reports on hospital nursing resources—staffing, education, and work environment—and multivariate logistic regressions to model their association with risk-adjusted postsurgical sepsis and mortality in 568 hospitals across four states. Better work environment quality was associated with lower odds of sepsis. While the likelihood of death among septic patients was nearly seven times that of non-septic patients, better nursing resources were associated with reduced mortality for all patients. Whereas the preponderance of sepsis research has focused on clinical interventions to prevent and treat sepsis, this study describes organizational characteristics hospital administrators may modify through organizational change targeting nurse staffing, education, and work environments to improve patient outcomes.

Non-classical monocytes and its potential in diagnosing sepsis post cardiac surgery

BackgroundSepsis is caused by a dysregulation of immune response to infection thatresults in very high mortality. Current laboratory tests and clinical criteria are inadequate to diagnose sepsis due to limited sensitivity and specificity. Circulating monocytes are important players in immune homeostasis and their altered HLA-DR expression indicate immune dysregulation. HLA-DR is an MHC Class II cell-surface receptor that can present foreign antigens to helper T cells and mount an inflammatory response. Therefore, we analyzed the variations in HLA-DR expression and the concentration of monocyte subsets for diagnosing post-surgical sepsis. MethodsIn this double-blinded prospective cohort study, we adopted immunophenotyping and quantification of antigen expression by flowcytometry to detect the changes in circulating monocyte subsets in patients undergoing cardiac surgery. Statistical analysis was performed to identify significant changes and based on the predictive potential of measured variables ROC curve analysis was done. ROC curve permitted the choice of appropriate cut-off values using which a diagnostic protocol was developed. ResultsWe observed that the monocyte subset concentrations in circulation varied differently after surgery. There was a significant downregulation of monocytic HLA-DR on both intermediate (p = 0.0477) and non-classical monocytes (p = 0.0333) at 48 h post-surgery. The monocyte subset analysis clearly showed that the patients with reduced pre-surgical non-classical monocyte count (p = 0.0430) coupled with post-surgical down-regulation of HLA-DR expression on the same subset had a higher incidence of developing sepsis after cardiac surgery. ConclusionsHere we are reporting for the first time, the significant influence of non-classical monocytes in inducing dysregulated host response and sepsis after cardiac surgery. Using multiple biomarkers associated with this monocyte subset, we established an algorithm for the diagnosis of sepsis at 48 h post cardiac surgery with 100% sensitivity and 69.23% specificity.

Sepsis within 30 days following elective surgeries in NSW public hospitals, January 2015-December 2017

IntroductionPostsurgical sepsis is a common complication, accounting for one-third of all sepsis cases and associated with higher risk of mortality.&#x0D; Objectives and ApproachThe Bureau of Health Information (BHI) in New South Wales (NSW), Australia produces independent reports and information about the performance of the healthcare system. Our report investigates the rate of sepsis within 30-days following surgery, and explores variation in risk standardised postoperative sepsis across NSW public hospitals. The study cohort and outcome definitions were drawn from existing international patient safety indicators, modified for appropriate use with Australian linked hospital and mortality data to identify patients transferred, or readmitted to any NSW public or private hospital with postoperative sepsis. Fine and Gray competing risks regression models were used to calculate risk-adjusted rates, and funnel plots were used to identify outliers.&#x0D; ResultsRate of 30-day postoperative sepsis was 0.9% among 66,143 adult elective surgeries that met the inclusion criteria during January 2015 to December 2017. Results showed around 33% of post-operative sepsis were identified as occurring during either a transfer or readmission to hospital. Hospital-level unadjusted rates of postsurgical sepsis ranged from 0% to 2% across more than 80 NSW public hospitals. The majority of hospitals (94%) had postoperative sepsis results lower or no different than expected.&#x0D; Conclusion/ImplicationsWe explored postoperative sepsis to help understanding of sepsis risk during the follow up period. Results showed a considerable number of postoperative sepsis cases would not have been identified without the use of linked data. Results on hospital risk standardised 30-day postoperative sepsis may prove useful as a screening tool for quality improvement in this area.

Diagnostic utility of serum procalcitonin as a biomarker of sepsis and infection in post-operative patients at tertiary care centre

Background: Procalcitonin (PCT), the precursor peptide of calcitonin, a hormone involved in calcium homeostasis, is present in normal subjects in extremely low serum levels (0.1 to 0.5 ng/ml). In response to bacterial infectious stimulation serum procalcitonin rises substantially and its role in inflammatory response includes chemotactic function modulation of inducible nitric oxide synthase and induction of cytokines, among other. The objective of this study to assess serum procalcitonin as a biomarker of sepsis and infection in post op patients.Methods: The present descriptive observational study was conducted at Department of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry from September 2018 to June 2020. Total 48 patients who had undergone surgery and presented with post-surgical sepsis were included. Data entered in MS excel sheet and analysed by using SPSS 24.0 version IBM USA.Results: Out of 48 cases, majority of cases i.e. 18 (37.5%) were from 36-50 years age group followed by 11 (22.9%) from 51-60 years age group. Prevalence of sepsis was 20.8%, septic shock 25%, severe sepsis 33.3% and SIRS 14.6%. Procalcitonin (PCT) assay shows positive in 47 (97.9%) cases. E. coli were isolated from 5 (45.5%) cases with PCT 2-10 as compared to 6 (16.7%) cases with PCT &gt;10.Conclusions: PCT shares remarkable promise as a marker of sepsis and can be used as a routine lab parameter. It was also found to be an accurate diagnostic parameter for differentiating various stages of sepsis and predicting the outcome.

Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

BackgroundSepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. MethodsData were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. ResultsA total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. ConclusionsPediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 59. Natural language processing of electronic medical records can identify sepsis following orthopedic surgery

BACKGROUND CONTEXT Quality improvement studies have provided surgeons with systematic insight on how to make changes to their practice to improve patient outcomes and avoid complications. However, currently most automated methods to identify patient complications for quality improvement studies rely on prelabeled administrative codes sampling data from fixed electronic medical databases. PURPOSE Medical notes contain a rich supply of medical data, yet the format of unstructured text has precluded these data from use in large retrospective analyses. Therefore, the utilization of free-text from electronic medical records using natural-language processing in combination with machine learning can provide an additional tool for patient complication surveillance and identification. The purpose of this study was to develop a machine learning algorithm that can identify postsurgical sepsis based on unstructured patient notes. STUDY DESIGN/SETTING This was a retrospective analysis of medical notes from the Medical Information Mart for Intensive Care (MIMIC III), a large, single-center database comprised of intensive care unit admissions data from 2001 to 2012. PATIENT SAMPLE A total of 947 patients from the orthopedic service were identified. Patients who experienced sepsis were identified using ICD-9 code (99592). A total of 15,004 notes were analyzed in total from the 947 patients. Of the 15,004 notes, 3,547 notes were from patients positive for sepsis and 11,457 notes were negative for sepsis defined by ICD-9 code. OUTCOME MEASURES Area under the receiver operating characteristic curve (ROC), accuracy, sensitivity, and specificity of the model were evaluated to assess performance of the model. METHODS Natural language processing was used to analyze unstructured narrative discharge notes and train a support vector machine algorithm to train a classifier to automatically identify patients with sepsis based solely on unstructured discharge notes. The data were randomized with 70% used for training and 30% used for testing. RESULTS The SVM algorithm identified sepsis notes with a sensitivity and specificity of 79% and 85%, respectively. The overall accuracy was 83.3% with area-under-receiver operating characteristic curve of 0.82. CONCLUSIONS Combining natural language processing with machine learning is a valid approach for automatic identification of sepsis using unstructured text from discharge notes. This method provides a robust survey of surgical encounters and may be used for real-time surveillance of postoperative complication risk and for automated identification of patient complications such as sepsis for quality improvement studies. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Derivation and validation of an exclusive pre-operative risk evaluation system in HIV-infected patients undergoing surgery

Background: A broadly applicable scoring tool for risk evaluation in HIV-infected surgical patients is imperative for improving outcomes and patient safety. Because sepsis has been considered as the major cause of mortality for HIV-infected post-surgical patients, the objective of this study was to develop a pre-operative risk stratification model that predicts the incidence of sepsis after surgical operations in HIV-infected patients. Methods: The scoring model was created by using inpatient databases, including 762 HIV-infected patients who underwent various surgical procedures from 2008 to 2014 in the Shanghai Public Health Clinical Center (SPHCC). A risk-point scale was developed with five variables for their predictive value of sepsis incidence using single and multi-factor logistical regressions. This model was validated with a receiver operating characteristic (ROC) curve with a Zhengzhou Sixth People Hospital (ZSPH) dataset (182 HIV-infected cases). Results: Post-operative sepsis was identified in 256 patients in the SPHCC dataset. The average total scores of the sepsis group and the non-sepsis group were 7.22 and 11.62, respectively. Using the predictive model of multi-factor logistical regression, the sensitivity and specificity were 0.95 and 93.6, respectively. The area under curve (AUC) score was 0.98[0.97, 0.99]. The result was much larger than five single-factor predicting models. In the 30 days after surgery, 15 patients died, and the mortality rate was around 2% in SPHCC. Post-operative sepsis was identified in 41 patients in the ZSPH dataset, and four sepsis patients died in the 30 days following surgery. The mortality was also around 2% at ZSPH. The AUC score of the same model was 0.86[0.82, 0.93]. Conclusion: The risk scoring system with the predictive model has high predictive accuracy. This indicates that it can help surgeons evaluate the incidence and risk of post-surgical sepsis before surgical procedures on HIV-infected patients.

Radiosurgery and stereotactic radiotherapy with cyberknife system for meningioma treatment.

Objective The aim of this work was to evaluate the impact of stereotactic radiosurgery/fractionated stereotactic radiotherapy with the Cyberknife system on local disease control, clinical outcome and toxicity in patients with meningioma, according to the site and histological grade of lesion. From January 2013 to April 2017, 52 patients with intracranial meningiomas were treated with the Cyberknife system. Twenty-four patients had undergone previous surgery: 38% gross total resection, 10% subtotal resection; 27 patients underwent no surgery; 22 patients had a recurrence of meningioma. Methods Radiosurgery was used for lesions smaller than 2 cm, stereotactic radiotherapy for lesions larger than 2 cm, or smaller but close to a critical site such as the optical chiasm, optic pathway or brainstem. Results Local control and clinical outcomes were analysed. Median follow-up was 20 months: six patients died, one after re-surgery died from post-surgical sepsis, three from heart disease. Progression-free survival had a mean value of 38.3 months and overall survival of 41.6 months. We evaluated at 12 months 28 patients (100% local control); at 24 months 19 patients (89% local control); at 36 months nine patients (89% local control). At baseline, 44/52 patients (85%) were symptomatic: 19 visual disorders, 17 motor disorders, six hearing disorders, 10 headache and six epilepsy. Visual symptoms remained unchanged in 52%, improved in 32%, resolved in 16%. Headache was improved in 40%, resolved in 10%, unchanged in 50%. Epilepsy was resolved in 17%, unchanged in 33%, worsened in 33%. Conclusions Stereotactic radiosurgery/fractionated stereotactic radiotherapy with Cyberknife provides a good local disease control, improving visual, hearing and motor symptoms.

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

Background: Postsurgical sepsis is one of the main causes of the high mortality and morbidity after open congenital heart surgery in infants. This study aimed to evaluate the role of cardiopulmonary bypass duration, thymectomy, surgical complexity, and nutritional status on postsurgical sepsis after open congenital cardiac surgery in infants.Methods: A total of 40 patients &lt;1 year of age with congenital heart disease, Aristotle Basic Score (ABS) ≥6 were followed for clinical and laboratory data before and after surgery until the occurrence of signs or symptoms of sepsis or until a maximum of 7 days after surgery. Bivariate analyses were performed. Variables with p≤0.200 were then included for logistic regression.Results: Duration of cardiopulmonary bypass ≥90 minutes was associated with 5.538 increased risk of postsurgical sepsis in comparison to those ≤90 minutes (80% vs 25%, RR=5.538, p=0.006). No association was observed between the incidence of postsurgical sepsis with poor nutritional status (86% vs 84%, RR=1.059, p=1.000), thymectomy (and 50% vs 76%, RR=0.481, p=0.157), and Aristotle Basic Score (p=0.870).Conclusion: Cardiopulmonary bypass time influences the incidence of sepsis infants undergoing open congenital cardiac surgery. Further studies are needed to elaborate a number of risk factors associated with the incidence of sepsis in this population.

Physician-led sepsis quality improvement team.

Over the last decade, hospitalizations for sepsis have more than doubled and the incidence of postsurgical sepsis tripled between 1997 and 2006. This upward trend is expected to continue for several reasons, including population-specific characteristics (e.g., age, chronic disease status) and health care-specific characteristics (eg, lack of understanding of sepsis, medical treatments that leave patients susceptible). Highly effective, focused, quality improvement teams need to be established in order to successfully manage this condition. Quality improvement, and specifically quality improvement in health care, has evolved substantially over the past few decades. This evolution has been pushed by government initiatives and private accrediting bodies that have exposed concerns regarding quality of care. Hospitals have responded with not only corrective actions but also actions that improve quality despite a lack of noted deficiencies (i.e., taking quality from "good" to "better"). Key components of a successful quality improvement program have been identified, as have components of successful quality improvement teams. By applying these components to a physician-led sepsis quality improvement team, hospitals can successfully decrease sepsis mortality and increase compliance with the application of sepsis best practice in the emergency department, intensive care unit, or non-intensive care unit nursing units.

Delayed post-surgical sepsis from Teflon felt: The diagnostic value of CT scanning, and a reminder for theatre staff

We report on 2 patients with surgical site infections following the inadvertent use of Teflon felt for haemostasis in elective and emergency surgery. CT scanning was superior to plain radiography in demonstrating the foreign bodies to enable planning of further surgical treatment.

Preoperative skin preparation: a historical perspective

The incidence of health-care-associated infections has reduced since skin antisepsis was introduced in the 19th century. Despite this, health-care-associated infections, including post-surgical sepsis, continue to cause significant morbidity and mortality. This article reviews the evidence for the use of preoperative skin preparations.