The two top physician concerns in general surgery patients post-operatively have been about pulmonary emboli (PE) and myocardial infarction (MI) with therapeutic measures for each of these potential conditions. Interestingly, a recent study by Laurie Barclay, MD, from Methodist Hospital Research Institute of Houston, Texas reported that sepsis and septic shock are more likely to occur post-operatively.
The study compared incidence, mortality, and risk factors for sepsis and septic shock with those for PE and MI in a patient population of 363,897 general surgery patients included from the 2005-2007 National Surgical Quality Improvement Program (NSQIP) data set. Sepsis occurred in 2.3% of patients, septic shock in 1.6% of patients while pulmonary embolism occurred 0.3%, and myocardial infarction in 0.2% . The greatest proportion of patients were 60 years of age or greater in the septic shock group (70.3%) compared with 40.2% of those with no sepsis and 51.7% of those with sepsis alone.
Comparatively speaking, patients entering the hospital for emergency surgery had a higher incidence of sepsis (4.5% versus 2.0% in the elective admit population). Risk of sepsis and septic shock were 6-fold higher in patients with other comorbid conditions and they had increased risks of mortality.
The study conclusions, based on record review of 363,897 patients, demonstrated that sepsis needed to be screened more acutely by general surgeons in order to prevent sepsis-associated morbidity and mortality in the their inpatient populations.
1. Sepsis in General Surgery
The 2005-2007 National Surgical Quality Improvement Program Perspective
Laura J. Moore, MD; Frederick A. Moore, MD; S. Rob Todd, MD; Stephen L. Jones, MD; Krista L. Turner, MD; Barbara L. Bass, MD
Arch Surg. 2010;145(7):695-700.
2. Archives of Surgery, Vol. 145, No. 7, July 2010
Sepsis in General Surgery: The 2005-2007 National Surgical Quality Improvement Program Perspective