Abstract
BackgroundOur aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients.MethodsWe conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis.ResultsWe studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14–3.53; 60-day mortality HR 2.45, 95% CI 1.94–3.10; 90-day mortality HR 2.31, 95% CI 1.85–2.87; 1-year mortality HR 1.71, 95% CI 1.46–2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56–7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45–2.89; very severe vs normal HR 2.17, 95% CI 1.49–3.17) were the only other significant independent predictors of increased 1-year mortality.ConclusionsAmong elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.
Highlights
Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients
We identified our study population on the basis of selection criteria developed by the Agency for Healthcare Research and Quality (AHRQ) for postoperative sepsis
Of the 144,503 patients who survived to hospital discharge, 1857 (12.9 per 1000 cases) were hospital survivors after post-operative sepsis (Fig. 1, Table 1)
Summary
Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients. Researchers in a recent study reported that 42.7% of severe sepsis survivors were re-hospitalized within 90 days [9], incurring higher costs, especially in the first year after hospital discharge, when costs are approximately three times the costs in the following 2–3 years [10] Given such high prevalence, significant risk of mortality, poor prognosis and high healthcare resource consumption, the U.S Agency for Healthcare Research and Quality (AHRQ) has proposed ‘post-operative sepsis’ as a key patient safety indicator, aiming to monitor potentially preventable surgical complications among elective surgical patients without serious medical conditions at admission [11]. This quality indicator has been widely used in the United States to measure aspects of patient safety and quality and to monitor the impact of quality improvement initiatives [3, 11,12,13,14]
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