Sepsis, a life-threatening bacterial infection of the blood, is an unwanted and costly complication to patients and the healthcare system. New research at UMDNJ-Robert Wood Johnson Medical School has identified major elective surgeries in which sepsis occurs most often post-procedure, along with extenuating conditions such as age, gender and type of hospital that increase the risk for sepsis. The study, published in the December issue of the Annals of Surgery, forms a basis to create post-operative procedures to reduce the risk of infection for patients, thereby saving lives and reducing health costs.
The research team evaluated more than 6.5 million elective surgical cases between 2002 and 2006, of which at least 78,669 cases developed postoperative sepsis. Led by Todd R. Vogel, MD, MPH, assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School and director of the vascular laboratory at Robert Wood Johnson University Hospital, the study is believed to be the largest-population-based analysis evaluating the rates, risk factors, mortality and cost associated with postoperative sepsis after elective surgery.
The research indicates that esophageal, pancreatic and gastric procedures represented the greatest risk for the development of postoperative sepsis. However, according to the study, these did not account for the greatest mortality rates. Thoracic, adrenal and hepatic (liver-related) procedures were associated with the highest risk for mortality when sepsis occurred.
"Patient safety can be dramatically improved through the use of checklists. However these are used mostly prior to surgery," says Vogel, a vascular surgeon. "The identification of high-risk groups in our study can be utilized to create intervention checklists following surgery that may reduce septic infections and mortality, along with the significant costs of treatment and hospitalization associated with postoperative complications."
Specifically, according to the study, cardiac and colorectal procedures are good targets for which to develop intervention measures to prevent sepsis, because they are performed more frequently than other surgeries. "Decreasing septic complications for these surgeries may have the most financial benefit to the healthcare system," Vogel says.
Sociodemographic factors and hospital characteristics also contributed to the risk of sepsis. The study showed that older patients, men, ethnic populations and those at an economic disadvantage were more likely to develop sepsis. The reasons for this finding remain unclear, and the researchers suggest that this may be secondary to educational level, access to care or the extent of the disease when treated.
Finally, the type of institution at which surgery is performed also contributes to the risk of developing sepsis. Patients in larger hospitals, in urban hospitals and in nonteaching hospitals were at an increased risk of post-operative infection. "This suggests that improvements to the delivery of care be directed toward the prevention of postoperative complications," says Vogel.
In addition to Vogel, members of the surgical outcomes research group in the department of surgery at UMDNJ-Robert Wood Johnson Medical School who contributed to the study were Viktor Dombrovskiy, MD, PhD, MPH, assistant professor; Jeffrey L. Carson, MD, professor; Alan M. Graham, MD, professor; and Stephen F. Lowry, MD, professor and chair of the department.