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A cross-sectional analysis of variables associated with morbidity and mortality in postoperative neurosurgical patients diagnosed with sepsis

  • Original Article - Neurosurgical intensive care
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Abstract

Background

Sepsis is a systemic, inflammatory response to infection associated with significant morbidity and mortality. There is a considerable lack of literature exploring sepsis in neurosurgery. We aimed to identify variables that were correlated with mortality and increased morbidity as defined by readmission and increased length of stay in postoperative neurosurgical patients that met a sepsis diagnosis.

Methods

A retrospective chart review was conducted of 105 patients who underwent a neurosurgical operation at our institution from 2012 to 2017 who were discharged with at least one sepsis diagnosis code and who did not have a preoperative infection. We identified variables that were correlated with mortality, readmission, and increased length of stay.

Results

Patients who survived were preferentially distributed towards lower ASA Physical Status Classification scores. A larger percentage of patients who did not survive had cranial surgery, whereas patients who survived were more likely to have undergone spinal surgery. Higher respiratory rates, higher maximum lactic acid levels, positive sputum cultures, and lower incoming Glasgow Coma Scores (GCS) were significantly correlated with mortality. A larger fraction of readmitted patients had positive surgical site cultures but had negative sputum cultures. Length of hospitalization was correlated with incoming GCS, non-elective operations, and Foley catheter, arterial line, central line, and endotracheal tube duration.

Conclusions

Neurosurgical postoperative patients diagnosed with sepsis may be risk stratified for mortality, readmission, and increased length of stay based on certain variables that may help direct their care. Further prospective studies are needed to explore causal relationships.

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Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Juliana Rotter

  2. Department of Neurological Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd. PHC 7, Washington, DC, 20007, USA

    Ehsan Dowlati, Kelsey Cobourn & Christopher Kalhorn

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Correspondence to Juliana Rotter.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Georgetown University Medical Center) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Our Institutional Review Board approved this single-center retrospective study (IRB # 2018-0021).

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Comments

Only very few studies have been conducted on the prevalence of sepsis following neurosurgery, let alone the risk factors for poor outcomes with this complication. In this retrospective single-center study of 105 patients recorded with sepsis after neurosurgery, the prevalence was recorded at 1.5% of all cases of neurosurgery. The single independent risk factor for readmission to hospital was a positive culture at the surgical site, whereas a medical history of cancer and a high maximum percentage of neutrophils emerged as independent predictors of death.

Kirsten Moeller

Copenhagen, Denmark

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Previous Presentation: Congress of Neurological Surgeons 2019 Annual Meeting, San Francisco, CA

This article is part of the Topical Collection on Neurosurgical Intensive Care

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Rotter, J., Dowlati, E., Cobourn, K. et al. A cross-sectional analysis of variables associated with morbidity and mortality in postoperative neurosurgical patients diagnosed with sepsis. Acta Neurochir 162, 2837–2848 (2020). https://doi.org/10.1007/s00701-020-04586-1

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