P48 – Acute Care Surgery – Infectious Complications and Mortality

Author(s):
Brandon Bruns, Matthew Lissauer, Ronald Tesoriero, Laura Buchanan, Mayur Narayan, Samuel Galvagno, Jose Diaz, University of Maryland; R Adams Cowley Shock Trauma Center

Background: Acute care surgery (ACS) has evolved in an effort to provide 24-hour surgical services for an array of general surgical emergencies. ACS services have been shown to improve outcomes and lead to more timely care. Yet, the etiology and timing of patient mortality has not been described.

Hypothesis: We hypothesized that infectious complications occur more frequently in ACS patients that die during their hospitalization.

Methods: Retrospective review of a prospectively collected institutional ACS (non-trauma) repository was performed (12/2009-12/2012). Demographic, admission, and discharge variables were collected. ICD-9 codes were used to identify patients with sepsis, shock, GI perforation, and/or peritonitis that was present on admission. Other hospital acquired infections (UTI, BSI, VAP) were also captured. The primary outcome was in-hospital mortality. Survivors were compared to those that died utilizing Fischer’s exact test to determine differences between the groups.

Results: 1,329 patients were included in the study. 53% were male with a mean age of 52±17 years and an average length of stay of 13±20 days. Overall mortality in-hospital was 8% (n=106). Of the patients who died, 32% (n=34) died within 7 days of admission. The majority of mortalities (56%) occurred after hospital day 14. Patients that died had sepsis, shock, perforation, and/or peritonitis on admission in 73% of cases (Table1).

Conclusions: In the current study, infectious complications present on admission occurred frequently in patients that when on to die. The addition of a subsequent HAI had little effect on mortality. Early identification of infectious complications and emergent source control with anti-microbial therapy holds promise for future efforts to improve outcomes in the ACS patient.