Healthcare

To compare incidence, mortality, and risk factors for sepsis and septic shock with those with pulmonary embolism (PE) and myocardial infarction (MI) in a patient population undergoing general surgery, a retrospective review has been established recently at American College of Surgeon National Surgical Quality Improvement Program (NSQIP) institutions.

Published in July issue of the Archives of Surgery, the researchers said that general surgery patients are more likely to have sepsis and septic shock than PE and MI.

Laura J. Moore, MD, from the Methodist Hospital, Weill Cornell Medical College in Houston, Texas, write, “we believe that sepsis screening could potentially prevent sepsis-associated morbidity and mortality in the general-surgery population. Before advocating mandatory sepsis screening programs in general-surgery patients, we need to further characterize and understand sepsis in these patients. Furthermore, we need to document the relative incidence and associated mortality of sepsis compared with the more commonly addressed preventable causes of postoperative mortality.”

363,387 general surgery patients involved in this cohort study from 2005 to 2007 in NSQIP data set.

Overall, from their findings, greater incidence of sepsis between elective surgery vs emergency surgery was 2.0% vs 4.5%, and for septic shock was 1.2% vs 4.9%.
In addition, risk of sepsis and septic shock were nearly 6-fold greater in patients with any comorbid condition. These patients also had a 22-fold increase in 30-day mortality rate.

The authors write, “the incidences of sepsis and septic shock exceed those of [PE] and [MI]. The risk factors for mortality include age older than 60 years, the need for emergency surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.”

Despite several limitation in this study such as retrospective design, possible misclassification from using the NSQIP definitions for sepsis and septic shock, and lack of data regarding cause of death, the study author conclude, “case mortality rates in patients with sepsis and septic shock exceed those of MI and PE combined by nearly 10-fold. Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying MI and PE…Further evaluation of the role of sepsis screening programs in other settings is critical and could significantly reduce sepsis-related mortality in general-surgery patients.”