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Identification of Sepsis Risk Factors Can Prevent Surgical Complications

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Sepsis is a severe, life-threatening bacterial infection of the bloodstream. In the health care setting, it is an unwanted and very costly complication to patients. Identification of risk factors can help hospitals and other healthcare settings make improvements to post-operative patient safety procedures.

Abdominal Surgical Procedures Have Greatest Risk for Post-Operative Sepsis

Researcher Todd R. Vogel MD MPH, an assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School, led a team that evaluated more than 6.5 elective surgical cases between 2002 and 2006 in which almost 79,000 developed postoperative sepsis.

While a bacterial infection can begin anywhere in the body, Vogel noted that esophageal, pancreatic and gastric surgical procedures represented the greatest risk for the development of postoperative sepsis. However, thoracic, adrenal, and hepatic procedures were associated with the highest risk for mortality when sepsis occurred.

Sociodemographic factors and hospital characteristics also contributed to the risk of sepsis. Vogel’s team found that older patients, men, ethnic populations, and those at an economic disadvantage were more likely to develop sepsis. Patients in larger hospitals, urban hospitals and those patients treated at non-teaching hospitals were also at greater risk of postoperative infection.

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The risk also increases with compromised immune systems, medical conditions such as diabetes, and those requiring invasive medical devices such as a urinary catheter or breathing tube.

Dr. Vogel suggests that hospitals use surgical checklists to reduce the risk of infection, paying particular attention to high-risk populations. He suggests starting with cardiac and colorectal procedures because they are performed more frequently than other surgeries and would have the most benefit to the health care system.

“Patient safety can be dramatically improved through the use of checklists. However these are used mostly prior to surgery,” said Dr. Vogel. “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.”

Post-surgical patients should also be aware of the earliest signs of sepsis, which include a change in mental status and hyperventilation. Other symptoms include chills, decreased urine output, fever or low body temperature (above 101.3 or below 95 F), lightheadedness due to low blood pressure, rapid heartbeat, shaking, and skin rash or areas of mottled skin.

Journal Reference:
Vogel, Todd R. MD, MPH; Dombrovskiy, Viktor Y. MD, PhD, MPH; Carson, Jeffrey L. MD; Graham, Alan M. MD; Lowry, Stephen F. MD, Postoperative Sepsis in the United States, Annals of Surgery, December 2010 - Volume 252 - Issue 6 - p 1065–1071
doi: 10.1097/SLA.0b013e3181dcf36e

Image Source: Wikimedia Commons