Trends in postoperative sepsis: are we improving outcomes?

Area of Science:

• Healthcare research
• Infectious disease epidemiology
• Surgical outcomes analysis

Background:

• Surgical site infections complicate millions of US operations annually.
• Surgical patients constitute 30% of all sepsis cases.
• Postoperative sepsis poses a significant threat to patient safety.

Purpose of the Study:

• To analyze trends in sepsis incidence, severity, and mortality post-surgery.
• To evaluate changes in septicemia pathogens over time.
• To identify disparities in postoperative sepsis development and outcomes.

Main Methods:

• Utilized 1990-2006 New Jersey hospital discharge data (HCUP-SID).
• Identified patients (≥18 years) with postoperative sepsis using AHRQ's definition.
• Defined severe sepsis as sepsis with organ dysfunction.

Main Results:

• Postoperative sepsis incidence rose significantly after both elective (0.67% to 1.74%) and non-elective (3.74% to 4.51%) surgeries.
• Severe sepsis proportion increased substantially for both groups (elective: 32.9% to 64.6%; non-elective: 47.7% to 69.9%).
• In-hospital mortality decreased for non-elective surgery (37.9% to 29.8%) but showed no significant change for elective surgery sepsis.

Conclusions:

• Non-elective surgery carries a higher risk of sepsis and death compared to elective procedures.
• Significant increases in sepsis and severe sepsis incidence observed across both surgical types.
• Mortality improvements noted for non-elective surgery, but not for elective surgery sepsis patients.
• Disparities in postoperative sepsis based on age, sex, and ethnicity warrant further investigation.