Risk of Sepsis in Patients Who Have Elective Surgeries

Analyses of a four-year study published in the Annals of Surgery indicate that 1.2% of patients who undergo elective surgeries developed postoperative sepsis.

Todd R. Vogel, MD, MPH, and colleagues from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, NJ, conducted a study to evaluate the incidence of postoperative sepsis after elective procedures, to define surgical procedures with the greatest risk for developing sepsis, and to evaluate patient and hospital confounders.

“The development of sepsis after elective surgical procedures imposes a significant clinical and resource utilization burden in the United States,” they wrote. To that end, they evaluated the development of sepsis after elective procedures in a nationally representative patient cohort and assessed the effect of sociodemographic and hospital characteristics on the development of postoperative sepsis.

The Nationwide inpatient sample was queried between 2002 and 2006, and patients developing sepsis after elective procedures were identified using the patient safety indicator “Postoperative Sepsis.” The investigators calculated case-mix-adjusted rates by using a multivariate logistic regression model for sepsis risk and an indirect standardization method.

Of the 6.5 million weighted elective surgical cases that met the inclusion criteria, a total of nearly 79,000 cases (1.21%) developed postoperative sepsis. Case-mix adjustment for age, race, gender, hospital bed size, hospital location, hospital teaching status, and patient income demonstrated esophageal, pancreatic, and gastric procedures represented the greatest risk for the development of postoperative sepsis, they found.

Thoracic, adrenal, and hepatic operations accounted for the greatest mortality rates if sepsis developed. The patient groups most likely to develop sepsis were those of increasing age, and African-American or Hispanic race. Decreased median household income, larger hospital bed size, urban hospital location, and nonteaching status were associated with greater rates of postoperative sepsis, according to the authors.

Vogel and colleagues concluded that “the development of postoperative sepsis is multifactorial and procedures, most likely to develop sepsis, did not demonstrate the greatest mortality after sepsis developed. Factors associated with the development of sepsis included race, age, hospital size, hospital location, and patient income.” They believe that further evaluation of high-risk procedures, populations, and environments may play a key role in reducing this costly complication.

For more:

• Postoperative Sepsis in the United States (Annals of Surgery)
• In-hospital Delay of Elective Surgery for High Volume Procedures: the Impact on Infectious Complications (Journal of the American College of Surgeons)
• Infectious Complications after Elective Vascular Surgical Procedures (Journal of Vascular Surgery)