Clinically Significant Infections in Surgical Mortality

Clinically significant infections (CSIs) are a common complication identified in cases of surgical mortality, associated with prolonged hospital stays, unplanned escalation of care and increased risk of death. This study aimed to examine the burden of CSIs in surgical deaths in the Australian Capital Territory and identify contributing factors and potential opportunities to improve surgical outcomes.

The Australian Capital Territory Audit of Surgical Mortality (ACTASM) collects data on in-hospital surgical mortality. This report compared cases with and without CSIs from 1 January 2015 to 31 December 2024.

Of 1089 cases, 363 had CSIs. Cases with CSIs had a higher proportion of comorbidities and longer lengths of stay but underwent fewer procedures. More patients acquired infections during than before admission. Sepsis was the most common infection acquired before admission, whereas pneumonia was the most common infection acquired during admission. General surgery had the highest number of CSIs, while urology had the highest proportion of CSIs relative to case volume. Rates of unplanned readmissions to hospital, unplanned admissions to critical care unit, unplanned returns to theatre and postoperative complications were higher in cases with CSIs.

Surgical patients with CSIs who died had more comorbidities and longer lengths of stay but were less likely to undergo an operation than those without CSIs. Unplanned events were higher in patients with CSIs. These findings underscore the significant impact of CSIs on patient outcomes, highlighting the need for effective preventive strategies and timely management to optimise patient outcomes.