Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.
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.


METHODS
Retrospective review.


METHODS
American College of Surgeons National Surgical Quality Improvement Program institutions.


METHODS
General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set.


METHODS
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.
Moore
Laura J
LJ
Department of Surgery, The Methodist Hospital, Weill Cornell Medical College, 6550 Fannin Street, Houston, TX 77030, USA. ljmoore@tmhs.org
Moore
Frederick A
FA
Todd
S Rob
SR
Jones
Stephen L
SL
Turner
Krista L
KL
Bass
Barbara L
BL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects; D016001:Confidence Intervals; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects; D015397:Program Evaluation; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult