Sepsis in General Surgery: The 2005-2007 National Surgical Quality Improvement Program Perspective

• Published in: Archives of surgery (Chicago. 1960) Vol. 145; no. 7; pp. 695 - 700
• Main Authors: Moore, Laura J, Moore, Frederick A, Todd, S. Rob, Jones, Stephen L, Turner, Krista L, Bass, Barbara L
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.07.2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Colectomy - adverse effects; Comparative analysis; Confidence Intervals; Digestive System Surgical Procedures - adverse effects; Female; General Surgery - statistics & numerical data; Heart attacks; Humans; Incidence; Intestine, Small - surgery; Male; Middle Aged; Mortality; Mortality - trends; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Odds Ratio; Pancreatectomy - adverse effects; Program Evaluation; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Quality Indicators, Health Care; Quality of Health Care; Retrospective Studies; Risk factors; Sepsis; Sepsis - epidemiology; Sepsis - etiology; Sepsis - mortality; Shock, Septic - epidemiology; Shock, Septic - etiology; Surgery; Surgical Procedures, Operative - adverse effects; United States; Vascular Surgical Procedures - adverse effects; Young Adult; United States
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2010.107

OBJECTIVE To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. DESIGN Retrospective review. SETTING American College of Surgeons National Surgical Quality Improvement Program institutions. PATIENTS General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. MAIN OUTCOME MEASURES Incidence, mortality rate, and risk factors for sepsis and septic shock. RESULTS Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P < .001). The need for emergency surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P < .001). The presence of any comorbidity increased the risk of sepsis and septic shock 6-fold (odds ratio, 5.8; 95% confidence interval, 5.5-6.2) and increased the 30-day mortality rate 22-fold (odds ratio, 21.8; 95% confidence interval, 17.6-26.9). CONCLUSIONS The incidences of sepsis and septic shock exceed those of pulmonary embolism and myocardial infarction. The risk factors for mortality include age older than 60 years, the need for emergency surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.Arch Surg. 2010;145(7):695-700-->