Sepsis in surgical inpatients: under-recognised but with significant consequences

• Published in: Irish journal of medical science Vol. 190; no. 2; pp. 763 - 769
• Main Authors: Reilly, Aoife, Ali, Ali Basil, Skally, Mairead, Gaughan, Leah, Hamilton, Vida, Troy, Alexandra, Humphreys, Hilary, McNamara, Deborah, Fitzpatrick, Fidelma
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2021
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Elective Surgical Procedures - adverse effects; Family Medicine; Female; General Practice; Hospitalization; Humans; Inpatients; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prospective Studies; Risk Factors; Sepsis - diagnosis; Young Adult; Frailty; Sepsis; General surgery; Surgical inpatients
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-020-02387-0

Background The true incidence of sepsis in surgical cohorts in Ireland remains unclear. According to inpatient audits, patients in surgical diagnostic groups (DRG) who developed sepsis had a longer length of stay and higher mortality rate compared with medical DRG patients who developed sepsis. Aims We investigated sepsis incidence on a general surgical ward to identify risk factors and strategies to improve management. Methods Demographics, admission and discharge details, infection risk factors, infection, and sepsis were studied prospectively on a surgical ward in July 2018. Results The mean age of 164 patients was 60.5 years (range 18–93 years), 107 (65.2%) were admitted electively, 16 (9.8%) were colonised with a multidrug-resistant organism (MDRO), and 30 (18.3%) were classified as frail on admission. Twelve (7.3%) developed sepsis (ward sepsis rate 118.2/10,000 bed days used). ‘Sepsis’ was documented in six cases and the national sepsis screening form used in four patients. Patients with sepsis were three times as likely to be MDRO-colonised (OR 3.56; 95% CI = 0.86–14.82; p = 0.065) or frail (OR 3.63; 95% CI = 1.07–12.35; p = 0.03), four times as likely to be an inpatient at the end of the study (OR 4.22, 96% CI 1.23–14.49; p = 0.01), and three times as likely to be readmitted (OR 3.46, 95% CI 1.02–11.76; p = 0.03). Conclusion Sepsis was under-documented, and barriers exist with use of the national sepsis screening form. Frailty, which is a sepsis risk factor, should be assessed pre-operatively to maximise prevention.