TY - JOUR
T1 - The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients
T2 - a population-based cohort study
AU - Ou, Lixin
AU - Chen, Jack
AU - Hillman, Ken
AU - Flabouris, Arthas
AU - Parr, Michael
AU - Assareh, Hassan
AU - Bellomo, Rinaldo
N1 - Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2017/2/20
Y1 - 2017/2/20
N2 - Background: Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients. Methods: We conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis. Results: We studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14-3.53; 60-day mortality HR 2.45, 95% CI 1.94-3.10; 90-day mortality HR 2.31, 95% CI 1.85-2.87; 1-year mortality HR 1.71, 95% CI 1.46-2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56-7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45-2.89; very severe vs normal HR 2.17, 95% CI 1.49-3.17) were the only other significant independent predictors of increased 1-year mortality. Conclusions: Among elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.
AB - Background: Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients. Methods: We conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis. Results: We studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14-3.53; 60-day mortality HR 2.45, 95% CI 1.94-3.10; 90-day mortality HR 2.31, 95% CI 1.85-2.87; 1-year mortality HR 1.71, 95% CI 1.46-2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56-7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45-2.89; very severe vs normal HR 2.17, 95% CI 1.49-3.17) were the only other significant independent predictors of increased 1-year mortality. Conclusions: Among elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.
UR - http://www.scopus.com/inward/record.url?scp=85013231277&partnerID=8YFLogxK
U2 - 10.1186/s13054-016-1596-7
DO - 10.1186/s13054-016-1596-7
M3 - Article
C2 - 28219408
AN - SCOPUS:85013231277
SN - 1364-8535
VL - 21
SP - 1
EP - 13
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 34
ER -