Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 17 , ISSUE 5 ( October, 2013 ) > List of Articles

RESEARCH ARTICLE

Predictors of septic shock following anastomotic leak after major gastrointestinal surgery: An audit from a tertiary care institute

Keywords : Anastomotic leakage, post-leak sepsis, septic shock

Citation Information : Predictors of septic shock following anastomotic leak after major gastrointestinal surgery: An audit from a tertiary care institute. Indian J Crit Care Med 2013; 17 (5):298-303.

DOI: 10.4103/0972-5229.120322

License: CC BY-ND 3.0

Published Online: 01-10-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Anastomotic leak is a serious complication after major gastrointestinal surgery and majority of deaths occur due to septic shock. Therefore, the early identification of risk factors of septic shock may help reduce the adverse outcomes. Objective: The aim of this audit was to determine the predictors of septic shock in patients with anastomotic leak after major gastrointestinal surgery. Design: Retrospective, audit. Materials and Methods: The patients admitted in the gastrosurgical intensive care unit ICU) of our institute between September 2009 and April 2012 with anastomotic leakage after surgery were identified. The ICU charts were retrieved from the database to identify the patients progressing to septic shock. A comparison of risk factors was made between the patients who developed septic shock (septic shock group) against the patients who did not (non-septic shock group). Results: The study sample comprised of 103 patients with anastomotic leak, of which 72 patients developed septic shock. The septic shock group had a higher APACHE II score, lower MAP, and higher HR at the time of ICU admission. They received greater transfusion of packed red blood cells during their ICU stay. Septic shock was more common after pancreaticojejunostomy and hepaticojejunostomy leaks. Conclusion: Presence of malignancy, chronic obstructive pulmonary disease (COPD), packed red blood cell transfusion, bacteremia, and hepaticojejunostomy or pancreaticojejunostomy leaks were independent predictors of mortality and length of ICU stay. To the best of our knowledge there are no available studies in the literature on the predictors of risk factors of septic shock in patients with anastomotic leakage.


PDF Share
  1. Veltkamp SC, Kemmeren JM, van der Graaf Y, Edlinger M, van der Werken C. Prediction of serious complications in patients admitted to a surgical ward. Br J Surg 2002;89:94 102.
  2. Madbouly KM, Senagore AJ, Remzi FH, Delaney CP, Waters J, Fazio VW. Perioperative blood transfusions increase infectious complications after ileoanal pouch procedures (IPAA). Int J Colorectal Dis 2006;21:807 13.
  3. Behrman SW, Zarzaur BL. Intra abdominal sepsis following pancreatic resection: Incidence, risk factors, diagnosis, microbiology, management and outcome. Am Surg 2008;74:572 8.
  4. Wichmann MW, Inthorn D, Andress HJ, Schildberg FW. Incidence and mortality of severe sepsis in surgical intensive care patients: The influence of patient gender on disease process and outcome. Intensive Care Med 2000;26:167 72.
  5. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373 83.
  6. Moran BJ, Heald RJ. Risk factors for and management of anastomotic leakage in rectal surgery. Colorectal Dis 2001;3:135 7.
  7. Schrock TR, Deveney CW, Dunphy JE. Factor contributing to leakage of colonic anastomosis. Ann Surg 1973;177:513 8.
  8. Hyman NH, Osler T, Cataldo P, Burns EH, Shackford SR. Anastomotic leaks after bowel resection: What does peer review teach us about the relationship to postoperative mortality? J Am Coll Surg 2009;208:48 52.
  9. Post IL, Verheijen PM, Pronk A, SIccama I, Houweling PL. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis 2012;27:765 72.
  10. Boyle NH, Manifold D, Jordan MH, Mason RC. Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg 2000;191:504 10.
  11. Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 2000;43:76 82.
  12. Telem DA, Chin EH, Nguyen SQ, Divino CM. Risk factors for anastomotic leak following colorectal surgery: A case control study. Arch Surg 2010;145:371 6.
  13. Perner A, Smith SH, Carlsen S, Holst LB. Red blood cell transfusion during septic shock in the ICU. Acta Anaesthesiol Scand 2012;56:718 23.
  14. Vamvakas EC, Carven JH, Hibberd PL. Blood transfusion and infection after colorectal cancer surgery. Transfusion 1996;36:1000 8.
  15. Farinas Alvarez C, Farinas MC, Fernandez Mazarrasa C, Llorca J, Casanova D, Delgado Rodriguez M. Analysis of risk factors for nosocomial sepsis in surgical patients. Br J Surg 2000;87:1076 81.
  16. Schuetz P, Yano K, Sorasaki M, Ngo L, St Hilaire M, Lucas JM, et al. Influence of diabetes on endothelial cell response during sepsis. Diabetologia 2011;54:996 1003.
  17. Schuetz P, Castro P, Shapiro NI. Diabetes and sepsis: Preclinical findings and clinical relevance. Diabetes Care 2011;34:771 8.
  18. Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest 2006;129:1432 40.
  19. Sawaya DE Jr, Johnson LW, Sittig K, McDonald JC, Zibari GB. Iatrogenic and noniatrogenic extrahepatic biliary tract injuries: A multi institutional review. Am Surg 2001;67:473 7.
  20. Matsusue S, Kashihara S, Koizumi S. Prediction of mortality from septic shock in gastrointestinal surgery by probit analysis. Jpn J Surg 1988;18:18 22.
  21. Haga Y, Wada Y, Takeuchi H, Ikejiri K, Ikenaga M. Prediction of anastomotic leak and its prognosis in digestive surgery. World J Surg 2011;35:716 22.
  22. Koushi K, Korenaga D, Kawanaka H, Okuyama T, Ikeda Y, Takenaka K. Using the E PASS scoring system to estimate the risk of emergency abdominal surgery in patients with acute gastrointestinal disease. Surg Today 2011;41:1481 5.
  23. Roman Marchant O, Orellana Jimenez CE, De Backer D, Melot C, Vincent JL. Septic shock of early or late onset: Does it matter? Chest 2004;126:173 8.
  24. Guidet B, Aegerter P, Gauzit R, Meshaka P, Dreyfuss D. CUB Rea Study Group. Incidence and impact of organ dysfunctions associated with sepsis. Chest 2005;127:942 51.
  25. Mokart D, Leone M, Sannini A, Brun JP, Tison A, Delpero JR, et al. Predictive perioperative factors for developing severe sepsis after major surgery. Br J Anaesth 2005;95:776 81.
  26. O′Keefe GE, Hybki DL, Munford RS. The G?A single nucleotide polymorphism at the 308 position in the tumor necrosis factor α promoter increases the risk for severe sepsis after trauma. J Trauma 2002;52:817 25.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.