A cross-sectional analysis of variables associated with morbidity and mortality in postoperative neurosurgical patients
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ORIGINAL ARTICLE - NEUROSURGICAL INTENSIVE CARE
A cross-sectional analysis of variables associated with morbidity and mortality in postoperative neurosurgical patients diagnosed with sepsis Juliana Rotter 1 & Ehsan Dowlati 2
&
Kelsey Cobourn 2 & Christopher Kalhorn 2
Received: 24 June 2020 / Accepted: 15 September 2020 / Published online: 22 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
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. Keywords Sepsis . Neurosurgery . Neurocritical care . Mortality . Readmission
Introduction Sepsis is a life-threatening organ dysfunction syndrome caused by dysregulated response to infection and is a leading cause of Previous Presentation: Congress of Neurological Surgeons 2019 Annual Meeting, San Francisco, CA This article is part of the Topical Collection on Neurosurgical Intensive Care * Juliana Rotter [email protected] 1
Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
2
Department of Neurological Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd. PHC 7, Washington, DC 20007, USA
morbidity and mortality worldwide [45]. The Sequential (Sepsis-Related) Organ Failure Assessment (SOFA) score is used to diagnose sepsis. From this, the more commonly used clinical tool of quick SOFA (qSO
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