P18 – Impact of Sepsis across Surgical Specialties

Author(s):
Rajesh Ramanathan, Patricia Leavell, Catherine Mays, Therese Duane, Virginia Commonwealth University Medical Center

Background: Sepsis is among the leading causes of death and rates of sepsis are tracked by the Agency for Healthcare Research and Quality (AHRQ) through administrative billing code data. Sepsis is a quality indicator and public reporting benchmark for the Centers of Medicare and Medicaid Services. Surgical patients undergoing procedures are at increased risk for infectious complications.

Hypothesis: To investigate the incidence of sepsis and its impact on outcomes amongst surgical patients undergoing procedures. To additionally study the specific impact of sepsis across various surgical specialties.

Methods: Patients undergoing procedures performed by a surgical service at our academic medical center between January 2010 and June 2013 were reviewed for sepsis by the presence of AHRQ sepsis-related procedural and diagnostic billing codes. Patient outcomes included hospital length of stay, intensive care unit (ICU) admission, ICU length of stay, mortality, and early mortality. Subgroup analysis investigated the incidence and impact of sepsis in procedures performed by various surgical specialties.

Results: 25,869 patients underwent a procedure by a surgical service and 858 (3.3%) patients developed sepsis during their hospital stay. Compared to all patients, patients with sepsis had significantly longer hospital stays, increased ICU admission and longer ICU stays. Patients who developed sepsis also had increased mortality and higher rates of early mortality (Table).
The incidence of sepsis was highest in patients with procedures performed by cardiothoracic surgery (8.0%), trauma/emergency surgery (7.6%) and plastic/reconstructive surgery (5.4%). Sepsis was associated with the greatest incidence of mortality amongst patients undergoing procedures by vascular surgery (36.8%), gastrointestinal/bariatric surgery (31.2%), and trauma/emergency surgery (27.1%).

Conclusions: Sepsis is not an uncommon condition and is associated with increased hospital stays, ICU admissions, ICU stays and mortality. Accurate benchmarking of sepsis is essential for development and monitoring of sepsis-reduction quality improvement initiatives.