Abstract
Background
Cancer patients are at increased risk for postoperative sepsis. However, studies addressing
the issue are lacking. We sought to identify preoperative and intraoperative predictors
of 30-d sepsis after major cancer surgery (MCS) and derive a postoperative sepsis
risk stratification tool.
Methods
Patients undergoing one of nine MCSs (gastrointestinal, urological, gynecologic, or
pulmonary) were identified within the American College of Surgeons National Surgical
Quality Improvement Program (2005-2011, n = 69,169). Multivariable adjusted analyses (MVA) were performed to identify the predictors
of postoperative sepsis. A composite sepsis risk score (CSRS) was constructed using
the regression coefficients of predictors significant on MVA. The score was stratified
into low, intermediate, and high risk, and its predictive accuracy for sepsis, septic
shock, and mortality was assessed using the area under the curve analysis.
Results
Overall, 4.3% (n = 2954) of patients developed postoperative sepsis. In MVA, Black race (odds ratio
[OR] = 1.30, P = 0.002), preoperative hematocrit <30 (OR = 1.40, P = 0.022), cardiopulmonary and cerebrovascular comorbidities (P < 0.010), American Society of Anesthesiologists score >3 (P < 0.05), operative time (OR = 1.002, P < 0.001), surgical approach (OR = 1.81, P < 0.001), and procedure type (P < 0.001) were significant predictors of postoperative sepsis. CSRS demonstrated favorable
accuracy in predicting postoperative sepsis, septic shock, and mortality (area under
the curve 0.72, 0.75, and 0.74, respectively). Furthermore, CSRS risk stratification
demonstrated high concordance with sepsis rates, 1.3% in low-risk patients versus 9.7% in high-risk patients. Similarly, 30-d mortality rate varied from 0.5% to 5.5%
(10-fold difference) in low-risk patients versus high-risk patients.
Conclusions
Our study identifies the major risk factors for 30-d sepsis after MCS. These risk
factors have been converted into a simple, accurate bedside sepsis risk score. This
tool might facilitate improved patient–physician interaction regarding the risk of
postoperative sepsis and septic shock.
Keywords
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Article info
Publication history
Published online: October 06, 2016
Accepted:
September 29,
2016
Received in revised form:
September 15,
2016
Received:
July 24,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
