Clinical- and surgery-specific risk factors for post-operative sepsis: a systematic review and meta-analysis of over 30 million patients

  • Philip Plaeke
  • Joris G. De Man
  • Samuel Coenen
  • Philippe G. Jorens
  • Benedicte Y. De Winter
  • Guy HubensEmail author
Review Article


Post-operative sepsis is a severe complication of surgery, which often worsens the clinical outcomes. While several risk factors have been identified, the importance of others remains uncertain. This systematic review and meta-analysis aimed to determine patient and surgery-related risk factors for post-operative sepsis. We reviewed Medline, the Web of Science, and the Cochrane library, systematically, for articles describing risk factors for sepsis. The role of eligible risk factors was investigated using a random-effects model, while analyzing univariate and multivariate data separately. Among 193 pro- and retrospective articles, comprising over 30 million patients, 38 eligible risk factors were selected for this meta-analysis. The patient-related risk factors associated with post-operative sepsis included male gender (odds ratio, OR 1.41), pre-existing heart failure (OR 2.53), diabetes (OR 1.41), and chronic kidney disease (OR 1.26). The surgery-related risk factors identified included emergency surgery (OR 3.38), peri-operative blood transfusion (OR 1.90), inpatient hospital stay (OR 2.31), and open surgery (OR 1.80). The adjusted overall incidence of surgical sepsis was 1.84%. In conclusion, multiple-patient and surgery-related risk factors are associated with the development of post-operative sepsis. Recognizing these risk factors could assist in the pre-operative identification of patients at risk of post-operative sepsis.


Post-operative sepsis Risk factors for sepsis Surgical sepsis 



American College of Chest Physicians


Society of Critical Care Medicine


Systemic inflammatory response syndrome


American College of Surgeons—National Surgical Quality Improvement Program


Nationwide Inpatient Sample


International Statistical Classification of Diseases and Related Health Problems


Preferred Reporting Items for Systematic Reviews and Meta-analyses


Odds ratio


Body mass index


Chronic obstructive pulmonary disease



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors have any biomedical or financial interests or potential conflicts of interest to declare.

Supplementary material

595_2019_1827_MOESM1_ESM.pdf (21 mb)
Supplementary file1 (PDF 21514 kb)


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Laboratory of Experimental Medicine and Pediatrics (LEMP)University of AntwerpWilrijk (Antwerp)Belgium
  2. 2.Department of Abdominal SurgeryAntwerp University HospitalEdegemBelgium
  3. 3.Department of Epidemiology and Social Medicine (ESOC)University of AntwerpWilrijk (Antwerp)Belgium
  4. 4.Department of Intensive Care MedicineAntwerp University HospitalEdegemBelgium
  5. 5.Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)University of AntwerpWilrijk (Antwerp)Belgium

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