Risk of Sepsis in the Postoperative Setting [48

Abstract

INTRODUCTION: Sepsis, a systemic inflammatory response syndrome (SIRS) associated with infection, can have severe complications. State reimbursement programs have instituted pay-for-performance initiatives to improve sepsis diagnosis and management. More than 75% of surgical intensive care unit patients develop SIRS; however, no data exist on the relationship between SIRS and sepsis in the routine postoperative setting. We aim to evaluate the incidence and risk factors for SIRS and sepsis postoperatively. METHODS: We conducted a prospective cohort study of adults admitted after abdominopelvic surgery at a university-affiliated county hospital. An electronic medical record query of inpatients having at least two concurrent abnormal vital signs identified those who developed SIRS postoperatively. Bivariate and regression analyses assessed factors affecting risk. RESULTS: Among 861 eligible patients, SIRS was found in 8.7%; for those with SIRS, sepsis occurred in 42.1%, severe sepsis in 6.7%, and septic shock in 4.0%. Sepsis spectrum disorders were more commonly associated with emergent than with elective surgery (7.3% compared with 2.4%, P=.001). There was a trend toward progressively increased length of stay (LOS) for patients with SIRS, sepsis alone, severe sepsis, and septic shock at 5.5, 5.7, 7.0, and 13.0 days, respectively. Only 6.5% of patients meeting medical criteria for sepsis were given an International Classification of Diseases, 9th Revision code for sepsis in their discharge summaries. CONCLUSION: Although postoperative SIRS is uncommon, more than half of the patients with SIRS will develop a sepsis spectrum disorder. We observed a strong correlation between sepsis, emergency surgery, and LOS. Future studies should evaluate the effect of risk-reducing interventions on the severity of postoperative sepsis.