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Odds of secondary complications increased for surgical patients with pneumonia, SSI
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Surgical inpatients who develop pneumonia or deep space surgical site infections have increased odds of developing secondary complications, according to data published in JAMA Surgery.
The data also indicate that other index surgical complications, specifically acute myocardial infarction and acute renal failure, increased the odds of secondary complications, including pneumonia.
“Index complications significantly alter the risk of specific secondary complications,” researchers from the Center for Surgery and Public Health at Brigham and Women’s Hospital, wrote. “This analysis should inform real-time risk estimation for clinical decision making and quality improvement strategies for targeted interventions aimed at preventing secondary complications.”
The researchers used data from the National Surgical Quality Improvement Program (NSQIP) Participant Use Data File to identify surgical patients from January 2005 to December 2011 who developed one of five index surgical complications: pneumonia, acute MI, acute renal failure, deep space SSI and bleeding or transfusion events. They created a reference cohort for each complication, which matched 1:1 identical patients who did not develop the complication, and compared outcomes.
Patients with index pneumonia had increased odds of 30-day reintubation (OR=17.1; 95% CI, 13.8-21.3), ventilatory failure (OR=15.9; 95% CI, 12.8-19.8), sepsis (OR=7.3; 95% CI, 6.2-8.6) and shock (OR=13; 95% CI, 10.4-16.2). These patients also had increased odds of secondary acute MI, pulmonary embolus and acute renal failure. Odds of mortality were 6.2 times greater for patients with pneumonia: 8.6% vs. 1.5%, a difference of 7.1% (95% CI, 6.4% to 7.8%).
Index deep space SSI was associated with increased odds of dehiscence (OR=30.4; 95% CI, 19.9-46.5) and sepsis (OR=13.1; 95% CI, 10.2-16.7). The odds of shock (OR=10.6; 95% CI, 6.4-17.7), kidney injury (OR=8.6; 95% CI, 3.9-18.8) and acute renal failure (OR=10.5; 95% CI, 3.8-29.3) also were greater for patients with deep space SSI.
Among patients with index acute MI, the odds of bleeding or transfusion events, pneumonia, cardiac arrest and reintubation were increased. Index acute renal failure increased the odds of cardiac arrest, reintubation, ventilator failure, bleeding or transfusion events and shock. There were no increased odds of any secondary complications among patients with index bleeding or transfusion events.
“Our analysis draws attention to the need to expand the definition of patient rescue to include intermediate outcomes, such as secondary complications, which can potentially be used for [failure to rescue] measurement,” the researchers wrote. “Rescue interventions that target patients with index complications are needed to arrest their progression to secondary complications and death.”
Disclosure: The researchers report no relevant financial disclosures.
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