肝内胆管空肠吻合手术严重并发症和病死率的多因素分析

目的探讨肝内胆管空肠吻合术的术后严重并发症及其危险因素。方法回顾性分析1990年1月至2004年8月暨南大学附属广州市红十字会医院163例行肝内胆管空肠吻合术病人的手术死亡和术后严重并发症的情况，并通过单因素分析和多因素分析评价其危险因素。结果住院期间病死率为11．7％（19／163），与手术相关的严重并发症发生率为23．9％（39／163）。Logistic回归分析显示，发生并发症危险因素依次是低蛋白血症、胆肠吻合口过多、病人有心肺合并症或糖尿病和恶性病变，而影响手术死亡率的危险因素是恶性病变、低蛋白血症和心肺合并症或糖尿病。结论术前肝功能不良是肝内胆管空肠吻合术术后并发症最主要的危险因素。手术医生正确掌握相关危险因素，提高手术技能是减少术后并发症的关键。     

结直肠癌患者住院期间死亡及并发症的危险因素分析

目的研究结直肠癌患者住院期间死亡和并发症的危险因素。方法收集北京大学第三医院1992—2005年收治的903例结直肠癌患者的临床资料,对自变量（包括30个术前危险因素、13个术中危险因素）和因变量（包括住院期间死亡和并发症）进行分析,用Logistic回归确定住院期间死亡和并发症的危险因素。结果住院期间的病死率为1.0%（9/903）,总并发症发生率为21.8%（197/903）。术后发生吻合口漏、脑血管意外、肺部感染的患者住院期间病死率明显升高。住院期间死亡的高危因素包括姑息性手术、总蛋白水平低;总并发症的危险因素包括采用腹会阴联合直肠癌切除术、术前血清钠〉145mmol/L、急诊手术、术前白细胞计数〉10000/mm^3、术中输血、合并糖尿病、姑息手术、高龄、低白蛋白血症;腹部伤口感染的危险因素为急诊手术、合并糖尿病、肥胖。结论术前对住院期间的病死率和并发症发生率进行预测,对临床评价手术风险有参考意义。     

医源性胆管损伤再手术原因分析及防治

目的：探讨医源性胆管损伤再手术的原因及防治。方法：对19年中129例胆管损伤108例再手术病人的损伤部位和再手术时机进行回顾性分析。结果：再手术率83．1％（108／129）；病人性别、年龄与再手术率无显著关系（P＞0．05）；再手术率与损伤原因、首次手术方式、损伤部位、再手术时机、再手术术式和手术操作等因素有关；LC胆管损伤再手术率（93．3％）高于OC手术胆管损伤（82．5％），相差显著（P＜0．05）；LC胆管损伤再手术率最高（92．3％），OC次之（84％）、OC＋胆管探查术最低（75％），三组间相差显著（P＜0．05）；损伤部位再手术率：肝总管、肝门部胆管、高位胆管分别为92．3％、88．5％、89．6％，三者无显著差异（P＞0．05），而胆总管损伤再手术率最低36．9％，与前三个部位再手术率相差非常显著（P＜0．01）。结论：胆管损伤力争手术中、术后早期（＜24h）确诊并处理，术后被迫急诊手术只能作为急救措施进行胆汁外引流术。LC术中及其术后和OC手术术后胆管损伤短期内（＜4周）修复应慎用，4周后行损伤近端胆管与空肠Roux-Y端侧一侧吻合较合适，并内置于T管支撑半年以上，可降低术后胆管再狭窄及返流性胆管炎的发生率，从而降低再手术率。     

动脉硬化性主髂动脉闭塞症血管重建的术式选择

目的分析解剖位和非解剖位术式对动脉硬化性主髂动脉闭塞的手术疗效、围手术期死亡和主要并发症的影响。方法对动脉硬化性主髂动脉闭塞症行主髂动脉重建术的382例患者的30d围手术期疗效、死亡和并发症的危险因素采用Logistic回归进行分析。结果共126名患者纳入分析。Logistic逐步回归显示手术有效率的影响因素有溃疡坏死（OR0．13，95％CI0．33～0．36，P=0．005）、是否同期远端血管重建（OR11．29，95％CI1．25～102．53，P=0．012）；围手术期主要并发症为13．5％，危险因素有年龄（OR37．13，95％CI3．29～48．53，P=0．003）、肾功能异常（OR5．71，95％CI1．25～25．02，P=0．024）、Goldman心脏风险（OR26．83，95％CI4．85～49．54，P=0．001）、术式选择（OR0．03，95％CI0．002～0．34，P=0．005）；围手术期死亡的危险因素有年龄（OR65．56，95％CI4．88～87．64，P=0．002）、Goldman心脏风险（OR23．86，95％CI3．90～45．99，P=0．032）、术式选择（OR0．02，95％CI0．001—0．262，P：0．005）。结论年龄70岁以上、中度以上Goldman心脏风险、肾功能异常是围手术期死亡和主要并发症的危险因素，对于这些高危患者需考虑采用解剖外术式以降低手术风险。     

结直肠癌并发急性肠梗阻患者围手术期风险分析

为探讨结直肠癌并发急性肠梗阻患者围手术期的风险,回顾接受外科手术治疗的545例结直肠癌患者资料,按患者是否并发急性肠梗阻分为两组,对比两组患者术前有无贫血、低蛋白血症、电解质紊乱、手术方式、术后并发症发生率、非计划再次手术率和围手术期病死率。结果显示,结直肠癌并发急性肠梗阻和未并发急性肠梗阻者术前贫血发生率分别为66．7％（106／159）和21．0％（81／386）,术前低蛋白血症发生率分别为23．9％（38／159）和10．4％（40／386）,术前电解质紊乱发生率分别为40．9％（65／159）和8．8％（34／386）,手术根治率分别为65．4％（104／159）和83．4％（322／386）,术后并发症发生率分别为39．6％（63／159）和21．0％（81／386）,围手术期病死率分别为8．2％（13／159）和1．0％（4／386）,组间比较差异均有统计学意义,P〈0.01。结直肠癌并发急性肠梗阻和未并发急性肠梗阻者非计划再次手术率分别为1．9％（3／159）和1．8％（7／386）,P〉0．05。结果表明,并发急性肠梗阻的结直肠癌患者术前合并症多,手术根治的比例低,术后并发症和病死率高,手术风险较大。     

233例胰十二指肠切除术后并发症及死亡危险因素多因素分析

目的 多因素分析胰十二指肠切除（PD）术后并发症及死亡危险因素。方法 233例行PD手术患者，平均年龄56岁；恶性病变210例，良性病变23例；胰头恶性肿瘤72例，壶腹周围恶性肿瘤138例。有重要器官系统合并症59例。根据病变部位分为胰腺组（81例）和壶腹周围组（152例）。结果 术后发生并发症63例（27．0％），早期并发症58例（24．9％），感染并发症28例（12．0％），多器官功能障碍15例（6．4％），出血并发症14例（6．0％），胰瘘12例（5．2％），再手术15例（6．4％），住院死亡16例（6．9％）。多因素分析提示，术后并发症的独立危险因素有重要脏器合并症、手术方式、主胰管直径及手术者经验。住院死亡的独立危险因素有术前血Cr水平、重要脏器合并症及手术者经验。再手术的独立危险因素有术前CA19—9水平、手术者经验、病灶直径及淋巴结转移。胰瘘的独立危险因素有Whipple术式、主胰管直径及手术者经验。结论 重要脏器合并症及手术者经验是PD术后并发症和住院死亡的独立危险因素；手术方式、主胰管直径及手术者经验是胰瘘的独立危险因素。因此，PD适应证及术式选择和技术的完善对于减少术后并发症及住院死亡至关重要。     

急性重症胆管炎的外科治疗及预后影响因素分析

目的探讨急性重症胆管炎（ACST）的手术时机、术式选择及预后影响因素。方法回顾性分析经外科治疗的189例ACST病人的临床资料。结果入院至手术时间≤24h123例,〉24h66例。手术原则均为胆道减压、胆汁引流。临床治愈163例,死亡36例,病死率19．05％。术后并发症68例。预后影响因素分析显示：年龄、术前脉搏、体温、血清胆红素、血白细胞、术前休克纠正与否、手术时机、术前合并症及术后器官功能不全为本病的危险因素。结论重视围手术期的处理,选择最佳手术时机和手术方式,对预后影响因素及时适当进行干预,可提高疗效,降低病死率。     

急性结石性胆囊炎腹腔镜手术时机及中转开腹影响因素的探讨

目的探讨腹腔镜手术治疗急性结石性胆囊炎的最佳时机以及影响中转开腹的因素。方法对468例行腹腔镜胆囊切除术的急性结石性胆囊炎病人的临床资料进行回顾性分析。将468例病人分为A（症状发作48h内手术）、B（48～72h内手术）、C（72h后手术）、D（保守治疗后再择期手术）4组。结果A、B、C、D4组的术后并发症发生率分别为3．48％（5／146）、3．69％（5／137）、5．88％（6／102）和3．17％（2／63），各组间术后并发症发生率并无显著性差异（P均〉0．05）；C组的手术时间较其他3组明显延长（P〈0．05），且手术中转率也显著高于其他各组（P〈0．05）；A组的手术时间较其他组短，开腹中转率也较其他组低（P〈0．05）；单因素分析结果显示体温、右上腹肌紧张、胆囊肿大、白细胞计数、胆囊壁厚度、胆囊颈部结石嵌顿、手术时机7个因素与中转开腹率显著相关（P〈0．05）。多因素回归分析显示白细胞计数和手术时机是影响腹腔镜中转开腹率的独立危险因素。结论急性结石性胆囊炎症状发作后48h内是腹腔镜手术的最佳时机，白细胞计数和手术时机是影响腹腔镜中转开腹率的独立危险因素。     

胰十二指肠切除术后并发症危险因素分析及治疗策略

目的探讨胰十二指肠切除术（PD）后并发症危险因素分析及相关并发症治疗策略。 方法选取2014年1月至2015年11月收治148例行PD术患者的完整资料,记录术后并发症发生情况,并采用单因素分析及Logistic回归方法进行危险因素分析。 结果患者行PD术后1个月并发症发生率为33.8%（50/148）,死亡4例（2.7%）。单因素分析显示：（1）黄疸持续时间、血总胆红素水平、手术时间及凝血原酶时间是影响术后出血的独立高危因素;（2）黄疸持续时间、血红蛋白和术中出血量是影响术后PF的独立高危因素;（3）血红蛋白和胆总管直径是影响术后BF的独立高危因素;（4）年龄和手术时间是影响术后肺部感染的独立高危因素;（5）术后出血、术后胰瘘和手术时间是影响术后腹腔感染的独立高危因素;（6）黄疸持续时间和糖尿病是影响术后胃排空障碍的独立高危因素,以上差异均有统计学意义（P<0.05）。Logistic多因素回归分析显示血总胆红素水平、黄疸持续时间、术中失血量及手术时间是影响PD术后主要的高危因素,差异均有统计学意义（P=0.042、0.031、0.047、0.019）。 结论总胆红素、黄疸持续时间、术中失血量及手术时间是影响PD术预后的主要高危因素,应规范化进行PD手术治疗,加强围手术期临床干预,以预防PD术后并发症发生。     

高龄病人实施胰十二指肠切除术危险因素的分析

目的：以实施胰十二指肠切除术的高龄病人,对照非高龄病人,分析术后发生并发症和死亡的原因,寻找高龄（〉70岁）病人发生术后并发症和死亡的危险因素。方法：回顾性分析164例连续的胰十二指肠切除术的病例资料,对其中高龄病人术前、术中和术后发生并发症和造成死亡的可能危险因素进行统计分析,判断这些因素与术后并发症及死亡的关系。结果：高龄病人在术前ASA评分、心功能分级上显著区别于非高龄（≤70岁）病人;且高龄病人术前心血管并存症也多于后者。高龄病人的术后院内死亡率高于非高龄病人,这些死亡的发生多出现在术后30d以后;高龄组和非高龄组中,术后并发症的发生率并无显著差异。单因素分析术后发生并发症的危险因素发现．术前低蛋白血症、术中失血大于1000mL是两大主要因素。而高龄病人术后院内死亡的危险因素是术后并发症、术前低蛋白血症和术前心功能分级〉2。结论：高龄病人胰十二指肠切除术后病死率较高,与其术前并存症及术前营养情况相关。术前改善高龄病人的营养状况,术中减少创伤和出血,加强术后重症监护及治疗、积极处理并存症和并发症是降低术后并发症和术后死亡发生的有效手段。     

Risk Factors for Morbidity and Mortality Following Gastroenterostomy

Background  Morbidity and mortality following traditional surgical treatment of gastric outlet obstruction is high. The aim of this work was to identify risk factors predictive of postoperative complications and mortality following gastroenterostomy. Methods  One-hundred sixty-five consecutive patients subjected to open gastroenterostomy from January 1996 through July 2003 were included. Data on vital signs and operative variables were retrieved from medical records and recorded retrospectively. Risk factors for postoperative complications and mortality within 30 days after operation were analyzed with multiple logistic regression. Results  The 30-day complication and death rates were higher after emergency operations (80% and 60%) than after elective operations (32% and 25%). A multivariate analysis disclosed that hypoalbuminemia (≤32 g/l), comorbidity, high age, and hyponatremia (<135 μmol/l) were significantly associated with postoperative death, whereas hypoalbuminemia, comorbidity, high age, and emergency operation were predictors of postoperative complications. Conclusions  Complications and mortality after gastroenterostomy due to gastric outlet obstruction are associated with modifiable and non-modifiable risk factors. Prior to surgery means should be taken to correct low albumin and sodium levels to prevent complications. In addition, the surgeon should consider alternative treatment modalities including laparoscopic gastroenterostomy, self-expanding metallic stents, or tube gastrostomy to relieve or palliate gastric outlet obstruction.     

Factores de riesgo para el desarrollo de complicaciones tras tratamiento quirúrgico del carcinoma broncopulmonar

IntroductionThe most suitable treatment in most early-stage lung cancer patients is surgical resection. Despite previously assessing each patient's status being relevant to detect possible complications inherent to surgery, no consensus has been reached on which factors are “high risk” in such patients. Our study aimed to analyse the morbidity and the mortality incidence associated with this surgery in our setting with a multicentre study and to detect risk parameters.MethodsA prospective analysis study with 3,307 patients operated for bronchopulmonary carcinoma in 24 hospitals. Study variables were age, TNM, gender, stage, smoking habit, surgery approach, surgical resection, ECOG, neoadjuvant therapy, comorbidity, spirometric values, and intraoperative and postoperative morbidity and mortality. A multivariate logistic regression analysis of the morbidity and mortality predictor factors was done.ResultsWe recorded 34.2% postoperative morbidity and 2.1% postoperative mortality. Gender, myocardial infarction, angina, ECOG ≥1, COPD, DLCO <60%, clinical pathological status, surgical resection and surgery approach were shown as morbidity and mortality predictor factors in lung cancer surgery in our series.ConclusionsThe main variables to consider when assessing the lung cancer patients to undergo surgery are gender, myocardial infarction, angina, ECOG, COPD, DLCO, clinical pathological status, surgical resection and surgery approach.     

Indication of Hepatopancreatoduodenectomy for Biliary Tract Cancer

Background The indication for a hepatopancreatoduodenectomy (HPD) in patients with advanced biliary tract cancer is still controversial, because this aggressive surgery might be associated with high mortality and morbidity rates. In this study, we review our experience with HPD for advanced biliary tract cancer, and seek to define the indication for HPD. Methods Eleven patients with biliary tract cancer underwent HPD at Wakayama Medical University Hospital between 1986 and 2004. Univariate analysis was used to assess independent variables of the mortality and morbidity associated with HPD. Results The rates of mortality and morbidity were 18% and 82%, respectively. Univariate analysis showed that the total serum bilirubin level before surgery and the hepatic parenchymal resection of more than two Healey’s segments correlated significantly with an increased risk of severe complications (P = 0.044, 0.0152, respectively). The 1-, 2-, and 3-year survival rates were 44%, 33%, and 11%, respectively. Conclusions Hepatopancreatoduodenectomy might offer a chance of long survival by yielding a tumor-free margin in selected patients who are able to tolerate such an aggressive operation, but the indication for this aggressive surgery should be carefully considered.     

Outcome after pancreaticoduodenectomy for periampullary cancer: An analysis from the veterans affairs national surgical quality improvement program

The aim of this study is to define the risk factors that predict adverse outcomes for patients undergoing pancreaticoduodenectomy for periampullary cancer in the Department of Veterans Affairs Healthcare System (VA). The VA National Surgical Quality Improvement Program prospectively collected data on 462 patients undergoing pancreaticoduodenectomy in 123 VA medical centers from 1990 to 2000. Independent variables included 68 preoperative and 12 intraoperative variables. The main outcome measures were 30-day postoperative mortality and morbidity, as measured by a set of 20 pre-defined complications. Predictive models for 30-day morbidity and mortality were constructed using logistic regression analysis. The 30-day morbidity rate was 45.9% (212/462). The 30-day postoperative mortality rate was 9.3% (43/462). Significant predictors of mortality included: preoperative serum albumin, American Society of Anesthesiologists classification, preoperative bilirubin >20mg/dl, and operative time. The use of preoperative biliary tract instrumentation did not predict postoperative death or septic complications. This study provides a set of preoperative risk factors that are predictive of adverse outcome following pancreaticoduodenectomy. These factors may assist in patient selection for this procedure and are likely to facilitate risk-adjusted comparison of pancreaticoduodenectomy outcomes between different health care systems. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002 (poster presentation).     

Renal impairment following biliary tract surgery

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of greater than 100 mumol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P less than 0.0005), pre-operative serum bilirubin (P less than 0.0005), and pre-operative urea (P less than 0.05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.     

胆总管结石行内镜下逆行胰胆管造影术治疗后结石复发的相关危险因素分析

目的对影响胆总管结石（CBDS）患者行内镜下逆行胰胆管造影（ERCP）术治疗后结石复发的相关危险因素进行研究并分析。 方法选取2014年3月至2017年3月在上海第六人民医院行ERCP术治疗的患者200例,将术后CBDS复发86例患者作为观察组,术后CBDS未复发114例作为对照组,结合两组患者资料进行单因素分析,对筛选出的危险因素进一步行多因素Logistic回归分析。 结果观察组患者年龄、病程、胆总管直径、有胆道手术史、胆道狭窄、有乳头旁憩室、结石大小（≥10 mm）、结石数量（≥2枚）的例数均显著多于对照组,差异有统计学意义（均P<0.05）;多因素分析显示,年龄、有胆道手术史、乳头旁憩室、结石数量≥2枚、胆总管直径、结石大小（直径≥10 mm）为患者术后复发的独立危险因素（P<0.05）。 结论患者年龄、有既往胆道手术史、合并乳头旁憩室、结石数量≥2枚、胆总管直径≥10 mm是CBDS胰胆管造影术后复发独立危险因素。     

胰十二指肠切除术后胆瘘发生的危险因素

目的明确胰十二指肠切除术后胆瘘发生的危险因素。方法回顾性分析1994年12月至2004年11月间接受胰十二指肠切除术的连续141例病人的病历资料。结果胆瘘的发生率为9.2%。单变量分析结果表明:糖尿病、术中输血量、手术失血量、胆管直径、术后血清白蛋白及血红蛋白水平为有意义的相关因素;经Logistic回归多变量分析确定了2个独立与胆瘘相关的变量,即手术失血量(OR=6.271)及胆管直径(OR=5.940)。胆瘘的预测方程为:P=1/[1 e~(-(-3.286 1.836手术失血量 1.782胆管直径))]。结论胆瘘的危险因素为手术失血量≥1000 ml及胆管直径<1.5 cm。     

One thousand fifty-six hepatectomies without mortality in 8 years

BACKGROUND: Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. HYPOTHESIS: By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. DESIGN: Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. SETTING: Tertiary referral center. PATIENTS: A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases. MAIN OUTCOME MEASURES: Operative mortality and morbidity rates. RESULTS: No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (>or=17 micro mol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study. CONCLUSIONS: Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.     

Pancreaticoduodenectomy for periampullary malignancies: the effect of bile colonization on the postoperative outcome

Objectives The presence of bacteria in the bile of patients undergoing biliary tract surgery has been proposed as associated to an increased incidence of postoperative complications. The present study was designed to determine whether colonization of the bile has an adverse effect in terms of postoperative infectious or noninfectious complications and mortality in a homogenous population of patients suffering from periampullary region malignancies, who all underwent resectional (curative) procedures. Materials and methods Between January 1997 and December 2002, 115 patients (n = 115) suffering from periampullary region malignancies underwent resectional procedures. Fifty-two of the above patients were referred having undergone preoperative internal biliary drainage. During the operation, bile was routinely isolated from the common bile duct and was sent for culture and sensitivity. Based on the bile culture results, the patients were divided in sterile and colonized group and were retrospectively compared in terms of postoperative outcome and mortality. Results Of the 115 bile cultures, 67 were colonized with bacteria and 48 were sterile. Postoperatively, 40 patients developed 35 noninfectious and 21 infectious complications. Univariate analysis did not disclose statistically significant differences in overall, noninfectious or infectious morbidity and mortality between the two groups of patients. Although not statistically significant, a higher incidence (22 vs 10%) of postoperative leaks in the colonized group of patients was noticed. Multiple regression analysis disclosed that colonized bile was independently related to the advanced age, preoperative biliary drainage presence, elevated preoperative serum bilirubin levels and low preoperative serum albumin levels but did not predispose to an increased postoperative morbidity, mortality, or reoperation rate. Conclusion The present study did not conclude in any statistically significant differences in the postoperative infectious and noninfectious morbidity as well as mortality, between colonized and sterile groups of patients who underwent resectional procedures for malignancies of the periampullary region. Although internal biliary drainage introduces microorganisms into the biliary tree, this colonization does not increase the risk of either infectious or noninfectious complications or postoperative death. Thus, the likelihood of bacterobilia should not contraindicate the procedure in selected cases.     

Postoperative sepsis and septic shock after hip fracture surgery

IntroductionThere is a paucity of research in the rates for sepsis and septic shock in the hip fracture population specifically, despite marked clinical and prognostic differences between these conditions. The purpose of this study was to determine the incidence, risk factors, and mortality rates for sepsis and septic shock as well as evaluate potential infectious causes in the surgical hip fracture population.MethodsThe ACS-NSQIP (2015–2019) was queried for patients who underwent hip fracture surgery. A backward elimination multivariate regression model was used to identify risk factors for sepsis and septic shock. Multivariate regression that controlled for preoperative variables and comorbidities was used to calculate the odds of 30-day mortality.ResultsOf 86,438 patients included, 871 (1.0%) developed sepsis and 490 (0.6%) developed septic shock. Risk factors for both postoperative sepsis and septic shock were male gender, DM, COPD, dependent functional status, ASA class ≥3, anemia, and hypoalbuminemia. Unique risk factors for septic shock were CHF and ventilator dependence. The 30-day mortality rate was 4.8% in aseptic patients, 16.2% in patients with sepsis, and 40.8% in patients who developed septic shock (p < 0.001). Patients with sepsis (OR 2.87 [95% CI 2.37–3.48], p < 0.001) and septic shock (OR 11.27 [95% CI 9.26–13.72], p < 0.001) had increased odds of 30-day mortality compared to patients without postoperative septicemia. Infections that preceded a diagnosis of sepsis or septic shock included urinary tract infections (24.7%, 16.5%), pneumonia (17.6%, 30.8%), and surgical site infections (8.5%, 4.1%).ConclusionsThe incidence of sepsis and septic shock after hip fracture surgery was 1.0% and 0.6%, respectively. The 30-day mortality rate was 16.2% in patients with sepsis and 40.8% in patients with septic shock. Potentially modifiable risk factors for both sepsis and septic shock were anemia and hypoalbuminemia. Urinary tract infections, pneumonia, and surgical site infections preceded the majority of cases of sepsis and septic shock. Prevention, early identification, and successful treatment of sepsis and septic shock are paramount to lowering mortality after hip fracture surgery.