Impact of Sepsis on Surgical Outcomes

BACKGROUND: Sepsis is among the leading causes of death in the United States, and patients undergoing surgical procedures are at greater risk for infectious complications. The incidence of sepsis and its association with outcomes among patients undergoing surgical procedures in various specialties were investigated. Additionally, the infectious sources and associated primary procedures were reported for sepsis-related deaths. METHODS: Patients undergoing procedures performed by surgical services at our academic medical center between January 2010 and June 2013 were reviewed. Sepsis was identified by the assignment of related ICD-9-CM billing codes. Patient outcomes included hospital length of stay, intensive care unit (ICU) admission, ICU length of stay, and death. A subset of sepsis-related deaths was reviewed further for infectious sources and primary procedure codes. RESULTS: A total of 25,522 patients underwent a procedure by a surgical service, and sepsis developed in 863 patients (3.38%) during their hospital stays. Overall, patients with sepsis had significantly longer hospital and ICU stays, greater likelihood of ICU admission, and a higher mortality rate. The incidence of sepsis was highest in patients with procedures performed by cardiothoracic surgery (8.39%), trauma/acute care surgery (7.55%), and plastic/reconstructive surgery (5.35%). Sepsis was associated with a significant increase in the mortality rate among vascular surgery, trauma/acute care surgery, and cardiothoracic surgery patients. The most common infectious sources in sepsis-related deaths were pulmonary infections (39.5%), blood stream infections (35.1%), and gastrointestinal infections (31.6%). The procedures associated with the greatest number of sepsis-related deaths were extracorporeal membrane oxygenation, small bowel resection, and insertion of implantable heart-assist systems. CONCLUSIONS: Sepsis is not an uncommon condition and is associated with longer hospital and ICU stays, greater likelihood of ICU admission, and a higher mortality rate. Accurate benchmarking of sepsis is essential for the development and monitoring of sepsis-reduction quality-improvement initiatives.