PMID- 33509730
OWN - NLM
STAT- MEDLINE
DCOM- 20210524
LR  - 20210524
IS  - 1878-7533 (Electronic)
IS  - 1550-7289 (Linking)
VI  - 17
IP  - 4
DP  - 2021 Apr
TI  - Postoperative sepsis after primary bariatric surgery: an analysis of MBSAQIP.
PG  - 667-672
LID - S1550-7289(20)30713-9 [pii]
LID - 10.1016/j.soard.2020.12.008 [doi]
AB  - BACKGROUND: Identifying patients at higher risk of postoperative sepsis (PS) may 
      help to prevent this life-threatening complication. OBJECTIVES: This study aimed 
      to identify the rate and predictors of PS after primary bariatric surgery. 
      SETTING: An analysis of the Metabolic and Bariatric Surgery Accreditation and 
      Quality Improvement Program (MBSAQIP) 2015-2017. METHODS: Patients undergoing 
      elective sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were 
      included. Exclusion criteria were revisional, endoscopic, and uncommon, or 
      investigational procedures. Patients were stratified by the presence or absence 
      of organ/space surgical site infection (OS-SSI), and patients who developed 
      sepsis were compared with patients who did not develop sepsis in each cohort. 
      Logistic regression was used to identify independent predictors of PS. RESULTS: 
      In total, 438,752 patients were included (79.4% female, mean age 44.6+/-12 years). 
      Of those, 661 patients (.2%) developed PS of which 245 (37.1%) developed septic 
      shock. Out of 892 patients with organ/space surgical site infections (OS-SSI), 
      298 (45.1%) developed sepsis (P <.001). Patients who developed PS had higher 
      mortality (8.8% versus .1%, P < .001), and this was highest in patients without 
      OS-SSI (11.8% versus 5%, P = .002). The main infectious complications associated 
      with PS in patients without OS-SSI were pneumonia and urinary tract infection. 
      Independent predictors of PS in OS-SSI included RYGB versus SG (OR, 1.8), and age 
      >/=50 years (OR, 1.4). Independent predictors of PS in patients without OS-SSI were 
      conversion to other approaches (OR, 6), operation length >2 hours (OR, 5.7), 
      preoperative dialysis (OR, 4.1), preoperative therapeutic anticoagulation (OR, 
      2.8), limited ambulation most or all of the time (OR, 2.4), preoperative venous 
      stasis (OR, 2.4), previous nonbariatric foregut surgery (OR, 2), RYGB versus SG 
      (OR, 2), hypertension on medication (OR, 1.5), body mass index >/=50 kg/m(2)(OR, 
      1.4), age >/=50 years (OR, 1.3), obstructive sleep apnea (OR, 1.3). CONCLUSION: 
      Development of OS-SSI after primary bariatric surgery is associated with sepsis 
      and increased 30-day mortality. Patients without OS-SSI who develop PS have a 
      significantly higher mortality rate compared with patients with OS-SSI who 
      develop PS. Early identification and intervention in patients with PS, including 
      those without OS-SSI, may improve survival in this high-risk group.
CI  - Copyright (c) 2020 American Society for Bariatric Surgery. Published by Elsevier 
      Inc. All rights reserved.
FAU - Hui, Benedict Y
AU  - Hui BY
AD  - Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, 
      Department of Surgery, Atrium Health, Charlotte, North Carolina.
FAU - Khorgami, Zhamak
AU  - Khorgami Z
AD  - Department of Surgery, School of Community Medicine, University of Oklahoma, 
      Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma, Oklahoma 
      City, Oklahoma. Electronic address: Zhamak-khorgami@ouhsc.edu.
FAU - Puthoff, Justin S
AU  - Puthoff JS
AD  - Department of Surgery, School of Community Medicine, University of Oklahoma, 
      Tulsa, Oklahoma.
FAU - Kuwada, Timothy S
AU  - Kuwada TS
AD  - Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, 
      Department of Surgery, Atrium Health, Charlotte, North Carolina.
FAU - Lim, Robert B
AU  - Lim RB
AD  - Department of Surgery, School of Community Medicine, University of Oklahoma, 
      Tulsa, Oklahoma.
FAU - Chow, Geoffrey S
AU  - Chow GS
AD  - Department of Surgery, School of Community Medicine, University of Oklahoma, 
      Tulsa, Oklahoma.
LA  - eng
PT  - Journal Article
DEP - 20201216
PL  - United States
TA  - Surg Obes Relat Dis
JT  - Surgery for obesity and related diseases : official journal of the American 
      Society for Bariatric Surgery
JID - 101233161
SB  - IM
MH  - Accreditation
MH  - Adult
MH  - *Bariatric Surgery/adverse effects
MH  - Female
MH  - Gastrectomy
MH  - *Gastric Bypass/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Obesity, Morbid/surgery
MH  - Postoperative Complications
MH  - Quality Improvement
MH  - Retrospective Studies
MH  - *Sepsis/epidemiology/etiology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Bariatric surgery
OT  - Roux-en-Y gastric bypass
OT  - Sepsis
OT  - Sleeve gastrectomy
EDAT- 2021/01/30 06:00
MHDA- 2021/05/25 06:00
CRDT- 2021/01/29 05:46
PHST- 2020/05/06 00:00 [received]
PHST- 2020/10/02 00:00 [revised]
PHST- 2020/12/06 00:00 [accepted]
PHST- 2021/01/30 06:00 [pubmed]
PHST- 2021/05/25 06:00 [medline]
PHST- 2021/01/29 05:46 [entrez]
AID - S1550-7289(20)30713-9 [pii]
AID - 10.1016/j.soard.2020.12.008 [doi]
PST - ppublish
SO  - Surg Obes Relat Dis. 2021 Apr;17(4):667-672. doi: 10.1016/j.soard.2020.12.008. 
      Epub 2020 Dec 16.