title: Incidence and mortality of postoperative sepsis in New South Wales, Australia, 2002-2009.
abstract: OBJECTIVE
  To describe the incidence and mortality of postoperative sepsis in New South Wales, Australia.
  
  
  METHODS
  A retrospective study of adult elective surgical admissions (n = 229 918) in 82 public acute care hospitals in NSW, 2002-2009.
  
  
  METHODS
  Changes in the incidence rate of post-operative sepsis and sepsis-related mortality.
  
  
  RESULTS
  Although the mortality rate among patients with sepsis decreased from 26.9% in 2002 to 20.2% in 2009 (P = 0.006 for adjusted trend), the incidence rate of sepsis increased from 12.7 to 15.8 per 1000 admissions (adjusted rate ratio [RR], 1.23; 95% CI, 1.06-1.42). Thus, the incidence rate of sepsis-related deaths remained unchanged (3.4 v 3.2 per 1000 admissions; adjusted RR, 0.90; 95% CI, 0.67-1.22), as did deaths from sepsis as a proportion of all elective surgical deaths (P = 0.96 for adjusted trend). The incidence rate of infections without a specified organism identified increased; was twice the rate of gram-positive infections (8.5 v 4.1 per 1000 admissions, P < 0.001); and was three times the rate of gram-negative infections (8.5 v 2.7 per 1000 admissions, P < 0.001). Also, compared with patients with gram-positive infections, patients with an unspecified infection were more likely to die (adjusted RR, 1.33; 95% CI, 1.13-1.57), but patients with gram-negative infections and mixed infections had a similar likelihood of death from their infection.
  
  
  CONCLUSIONS
  Over 8 years, the mortality from postoperative sepsis decreased, but its incidence rate increased, resulting in a lack of improvement in the incidence rate of sepsis-related deaths. The increasing incidence of postoperative sepsis and the poor record of identification of causative organisms remain a significant public health challenge.
authors.affiliation: Simpson Centre for Health Services Research, University of New South Wales, Sydney, NSW, Australia. lixin.ou@unsw.edu.au.
authors.forename: Lixin
authors.initials: L
authors.lastname: Ou
authors.affiliation: Simpson Centre for Health Services Research, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Burrell
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
authors.affiliation: Simpson Centre for Health Services Research, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hillman
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Intensive Care Unit, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Parr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D015996:Survival Rate; D055815:Young Adult