Sepsis After Elective Aortic Root Replacement: An Analysis Using the National Inpatient Sample

Abstract

Introduction: Sepsis after aortic root replacement (ARR) is a severe complication that results in significant postoperative mortality. To date, risk factors associated with development of sepsis after ARR have not been thoroughly studied. The objective of this study was to identify risk factors of sepsis following elective ARR using the National Inpatient Sample (NIS) database.

Methods: The NIS core files of the Health care Cost and Utilization Project database from 2017 to 2022 were used to identify adults (≥18 y) who underwent elective ARR. Demographic, comorbidity, and other health factors selected from the NIS dataset were analyzed to construct a multivariable logistic regression model.

Results: A total of 66,530 patients who underwent elective ARR between 2017 and 2022 were identified, and the incidence of sepsis was 2.1% (n = 1380). Weight loss/cachexia (odds ratio (OR) and [95% confidence interval]: 5.98 [4.27, 8.38], P < 0.001), neurologic disorders (OR: 3.08 [2.26, 4.19], P < 0.001), renal failure (OR: 2.16 [1.56, 2.99], P < 0.001), heart failure (OR: 2.11 [1.59, 2.79], P < 0.001), liver disease (OR: 2.03 [1.23, 3.36], P = 0.006), chronic lung disease (OR: 1.73 [1.26, 2.38], P = 0.001), cerebrovascular disease (OR: 1.67 [1.18, 2.35], P = 0.004), aortic dissection (OR: 1.62 [1.02, 2.57], P = 0.042), and coagulopathy (OR: 1.52 [1.16, 1.99], P = 0.003) were comorbidities associated with increased odds of sepsis development following ARR. Presence of thoracic aortic aneurysm (OR: 0.48 [0.34, 0.68], P < 0.001), hypertension (OR: 0.53 [0.39, 0.72], P < 0.001), hyperlipidemia (OR: 0.65 [0.49, 0.87], P = 0.003), and tobacco use (OR: 0.36 [0.26, 0.50], P < 0.001) were associated with decreased odds of sepsis development.

Conclusions: Health care professionals should be aware of the risk factors associated with the development of sepsis after ARR, as well as patient characteristics that are protective against sepsis. High risk patients should undergo preoperative optimization of modifiable risk factors to minimize postoperative sepsis risk.

Keywords: aortic root replacement; cardiac surgery complications; national inpatient sample; perioperative outcomes; postoperative sepsis; risk factors.