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Abstract

Introduction: The risk for development of severe sepsis or septic shock (SS/SS) is a great concern in the cardiothoracic surgery patient population. The Surviving Sepsis Campaign has recommended sepsis bundles that have been shown to reduce mortality in patients with SS/SS. Our group has previously shown that using an early sepsis initiative in the surgical population as a whole has significant benefit; however, there is little data looking at the particularly vulnerable cardiothoracic surgery cohort. Hypothesis: We believe that implementation of an early sepsis initiative will improve outcomes in the cardiothoracic surgery patient population. Methods: A retrospective review of 460 patients receiving the diagnosis of SS/SS after undergoing cardiothoracic surgery during hospital admission from November of 2003 through December of 2009 was conducted at an academic medical center. Mortality, length of hospital stay (LOS), intensive care unit (ICU) days, and ventilator days were calculated for the pre-intervention (November 2003-December 2005, N=148) and post-intervention (January 2006-December 2009, N=312) groups. Statistical analysis was conducted using T-test for continuous variables and chi-squared analysis for categorical variables. A p-value of 0.05 or less was considered significant. Results: The in hospital mortality rate slightly decreased from 16.22% to 15.70% after implementation of the early sepsis initiative (p=0.892). LOS was reduced from a mean of 31.66 ± 34.38 days to 24.12 ± 25.12 days (p=0.018). ICU days decreased from 22.24 ± 35.80 days to 13.29 ± 23.71 days (p=0.008). Ventilator days were reduced from 16.71 ± 28.88 days to 9.03 ± 11.77 days (p=0.005). Conclusions: The results demonstrate that the implementation of early best practice sepsis initiative leads to significant reduction in hospital LOS, ICU days, and ventilator days in the cardiothoracic surgical patient population. However, there was not a significant decrease in mortality. This is in contrast to the larger surgical population, in which significant mortality benefit has been observed. There is a great need for additional studies in reducing mortality in the SS/SS cardiothoracic surgery cohort.