High Rates of Postop Sepsis Suggest Need for Screening

The rates of sepsis and septic shock following general surgery are so excessive that identifying high-risk patients and screening them at 12-hour intervals for signs and symptoms may be warranted, according to a report.

An analysis of data on more than 360,000 general surgery patients showed that those at highest risk are older than 60 years of age, undergo emergency rather than elective surgery, and have a major comorbidity. The findings suggest that patients with any of these three risk factors “warrant a high index of suspicion…and that this patient population would most likely benefit from mandatory sepsis screening,” said Dr. Laura J. Moore and her associates at Methodist Hospital, Houston.

To date, programs to limit perioperative complications have focused on prevention plus early recognition and treatment of thromboembolism, surgery-related MI, and surgical site infections. These efforts have produced a significant decline in all three complications and in related mortality.

But the incidences of postoperative sepsis and septic shock have remained alarmingly high—far greater than those of thromboembolism and MI—and the associated mortality also remains excessively high (50%).

To characterize the severity and extent of postoperative sepsis and septic shock, Dr. Moore and her colleagues analyzed information that had been collected prospectively in the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) database. They examined data on 363,897 patients treated at 121 academic and community hospitals in 2005-2007.

A total of 8,350 patients (2.3%) developed sepsis, and 5,977 (1.6%) developed septic shock following general surgery. In comparison, pulmonary embolism developed in 0.3% and MI in 0.2%.

The development of sepsis raised the rate of 30-day mortality fourfold, whereas septic shock raised it 33-fold, the researchers said (Arch. Surg. 2010;145:695-700).

“Septic shock occurs 10 times more frequently than MI and has the same mortality rate; thus, it kills 10 times more people,” they said. “Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying MI and PE.”

Because closer monitoring of all surgical patients for signs and symptoms of sepsis is not realistic, it should be limited to those at highest risk. In this analysis, the percentage of patients older than age 60 was only 40% in the overall study group, compared with 52% in the group that developed sepsis and 70% in the group that developed septic shock.

The rate of sepsis was only 2% and that of septic shock was only 1% in patients undergoing elective procedures, compared with rates of approximately 5% for both sepsis and septic shock in patients undergoing emergency procedures.

Finally, approximately 90% of patients who developed sepsis and 97% of those who developed septic shock had at least one major comorbidity, compared with only 70% of those who did not develop sepsis. “The presence of any of the NSQIP–documented comorbidities increased the odds of developing sepsis or septic shock by sixfold” and raised the 30-day mortality by 22-fold, Dr. Moore said.

They found that clinicians at Methodist did not always accurately identify sepsis at the bedside in the most timely way. “A distinct window of early intervention exists in which the septic source must be eliminated and physiologic derangements corrected,” the investigators said.

The hospital implemented a program in which patients with any of these risk factors were screened every 12 hours for heart rate, white blood cell count, temperature, and respiratory rate. The program decreased sepsis-related mortality.

Disclosures: This study was supported by the Methodist Hospital Research Institute, Houston. No disclosures were reported.

The rates of sepsis and septic shock following general surgery are so excessive that identifying high-risk patients and screening them at 12-hour intervals for signs and symptoms may be warranted, according to a report.

An analysis of data on more than 360,000 general surgery patients showed that those at highest risk are older than 60 years of age, undergo emergency rather than elective surgery, and have a major comorbidity. The findings suggest that patients with any of these three risk factors “warrant a high index of suspicion…and that this patient population would most likely benefit from mandatory sepsis screening,” said Dr. Laura J. Moore and her associates at Methodist Hospital, Houston.

To date, programs to limit perioperative complications have focused on prevention plus early recognition and treatment of thromboembolism, surgery-related MI, and surgical site infections. These efforts have produced a significant decline in all three complications and in related mortality.

But the incidences of postoperative sepsis and septic shock have remained alarmingly high—far greater than those of thromboembolism and MI—and the associated mortality also remains excessively high (50%).

To characterize the severity and extent of postoperative sepsis and septic shock, Dr. Moore and her colleagues analyzed information that had been collected prospectively in the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) database. They examined data on 363,897 patients treated at 121 academic and community hospitals in 2005-2007.

A total of 8,350 patients (2.3%) developed sepsis, and 5,977 (1.6%) developed septic shock following general surgery. In comparison, pulmonary embolism developed in 0.3% and MI in 0.2%.

The development of sepsis raised the rate of 30-day mortality fourfold, whereas septic shock raised it 33-fold, the researchers said (Arch. Surg. 2010;145:695-700).

“Septic shock occurs 10 times more frequently than MI and has the same mortality rate; thus, it kills 10 times more people,” they said. “Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying MI and PE.”

Because closer monitoring of all surgical patients for signs and symptoms of sepsis is not realistic, it should be limited to those at highest risk. In this analysis, the percentage of patients older than age 60 was only 40% in the overall study group, compared with 52% in the group that developed sepsis and 70% in the group that developed septic shock.

The rate of sepsis was only 2% and that of septic shock was only 1% in patients undergoing elective procedures, compared with rates of approximately 5% for both sepsis and septic shock in patients undergoing emergency procedures.

Finally, approximately 90% of patients who developed sepsis and 97% of those who developed septic shock had at least one major comorbidity, compared with only 70% of those who did not develop sepsis. “The presence of any of the NSQIP–documented comorbidities increased the odds of developing sepsis or septic shock by sixfold” and raised the 30-day mortality by 22-fold, Dr. Moore said.

They found that clinicians at Methodist did not always accurately identify sepsis at the bedside in the most timely way. “A distinct window of early intervention exists in which the septic source must be eliminated and physiologic derangements corrected,” the investigators said.

The hospital implemented a program in which patients with any of these risk factors were screened every 12 hours for heart rate, white blood cell count, temperature, and respiratory rate. The program decreased sepsis-related mortality.

Disclosures: This study was supported by the Methodist Hospital Research Institute, Houston. No disclosures were reported.

The rates of sepsis and septic shock following general surgery are so excessive that identifying high-risk patients and screening them at 12-hour intervals for signs and symptoms may be warranted, according to a report.

An analysis of data on more than 360,000 general surgery patients showed that those at highest risk are older than 60 years of age, undergo emergency rather than elective surgery, and have a major comorbidity. The findings suggest that patients with any of these three risk factors “warrant a high index of suspicion…and that this patient population would most likely benefit from mandatory sepsis screening,” said Dr. Laura J. Moore and her associates at Methodist Hospital, Houston.

To date, programs to limit perioperative complications have focused on prevention plus early recognition and treatment of thromboembolism, surgery-related MI, and surgical site infections. These efforts have produced a significant decline in all three complications and in related mortality.

But the incidences of postoperative sepsis and septic shock have remained alarmingly high—far greater than those of thromboembolism and MI—and the associated mortality also remains excessively high (50%).

To characterize the severity and extent of postoperative sepsis and septic shock, Dr. Moore and her colleagues analyzed information that had been collected prospectively in the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) database. They examined data on 363,897 patients treated at 121 academic and community hospitals in 2005-2007.

A total of 8,350 patients (2.3%) developed sepsis, and 5,977 (1.6%) developed septic shock following general surgery. In comparison, pulmonary embolism developed in 0.3% and MI in 0.2%.

The development of sepsis raised the rate of 30-day mortality fourfold, whereas septic shock raised it 33-fold, the researchers said (Arch. Surg. 2010;145:695-700).

“Septic shock occurs 10 times more frequently than MI and has the same mortality rate; thus, it kills 10 times more people,” they said. “Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying MI and PE.”

Because closer monitoring of all surgical patients for signs and symptoms of sepsis is not realistic, it should be limited to those at highest risk. In this analysis, the percentage of patients older than age 60 was only 40% in the overall study group, compared with 52% in the group that developed sepsis and 70% in the group that developed septic shock.

The rate of sepsis was only 2% and that of septic shock was only 1% in patients undergoing elective procedures, compared with rates of approximately 5% for both sepsis and septic shock in patients undergoing emergency procedures.

Finally, approximately 90% of patients who developed sepsis and 97% of those who developed septic shock had at least one major comorbidity, compared with only 70% of those who did not develop sepsis. “The presence of any of the NSQIP–documented comorbidities increased the odds of developing sepsis or septic shock by sixfold” and raised the 30-day mortality by 22-fold, Dr. Moore said.

They found that clinicians at Methodist did not always accurately identify sepsis at the bedside in the most timely way. “A distinct window of early intervention exists in which the septic source must be eliminated and physiologic derangements corrected,” the investigators said.

The hospital implemented a program in which patients with any of these risk factors were screened every 12 hours for heart rate, white blood cell count, temperature, and respiratory rate. The program decreased sepsis-related mortality.

Disclosures: This study was supported by the Methodist Hospital Research Institute, Houston. No disclosures were reported.