Risk factors for postoperative sepsis in patients with gastrointestinal perforation

doi:10.12998/wjcc.v8.i4.670

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 8, Issue 4

This Article

Academic Content and Language Evaluation of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (8099)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-1) series, Tables (1-4) series.

Item

Count

PDF

308

WORD

169

HTML

3604

Figures (1-1)

241

Tables (1-4)

347

Sum=4669

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

548

Download

700

Sum=1248

Publishing Process of This Article

Item

Count

Browse

757

Download

1425

Sum=2182

Feb 26, 2020 (publication date) through Apr 29, 2024

Times Cited of This Article

Times Cited (3)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Clin Cases. Feb 26, 2020; 8(4): 670-678
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.670

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
Clinical variables	Enrolled patients (n = 212)	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.

Citation: Xu X, Dong HC, Yao Z, Zhao YZ. Risk factors for postoperative sepsis in patients with gastrointestinal perforation. World J Clin Cases 2020; 8(4): 670-678
URL: https://www.wjgnet.com/2307-8960/full/v8/i4/670.htm
DOI: https://dx.doi.org/10.12998/wjcc.v8.i4.670