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Postoperative Sepsis in the United States

Vogel, Todd R. MD, MPH*,†; Dombrovskiy, Viktor Y. MD, PhD, MPH*,†; Carson, Jeffrey L. MD*,†; Graham, Alan M. MD; Lowry, Stephen F. MD*,†

doi: 10.1097/SLA.0b013e3181dcf36e
Original Articles: ORIGINAL STUDY

Objectives: To evaluate the incidence of postoperative sepsis after elective procedures, to define surgical procedures with the greatest risk for developing sepsis, and to evaluate patient and hospital confounders.

Background Data: The development of sepsis after elective surgical procedures imposes a significant clinical and resource utilization burden in the United States. We evaluated the development of sepsis after elective procedures in a nationally representative patient cohort and assessed the effect of sociodemographic and hospital characteristics on the development of postoperative sepsis.

Methods: The Nationwide inpatient sample was queried between 2002 and 2006 and patients developing sepsis after elective procedures were identified using the patient safety indicator “Postoperative Sepsis” (PSI-13). Case-mixa djusted rates were calculated by using a multivariate logistic regression model for sepsis risk and an indirect standardization method.

Results: A total of 6,512,921 weighted elective surgical cases met the inclusion criteria and 78,669 cases (1.21%) developed postoperative sepsis. Case-mix adjustment for age, race, gender, hospital bed size, hospital location, hospital teaching status, and patient income demonstrated esophageal, pancreatic, and gastric procedures represented the greatest risk for the development of postoperative sepsis. Thoracic, adrenal, and hepatic operations accounted for the greatest mortality rates if sepsis developed. Increasing age, Blacks, Hispanics, and men were more likely to develop sepsis. Decreased median household income, larger hospital bed size, urban hospital location, and nonteaching status were associated with greater rates of postoperative sepsis.

Conclusions: The development of postoperative sepsis is multifactorial and procedures, most likely to develop sepsis, did not demonstrate the greatest mortality after sepsis developed. Factors associated with the development of sepsis included race, age, hospital size, hospital location, and patient income. Further evaluation of high-risk procedures, populations, and environments may assist in reducing this costly complication.

The incidence of postoperative sepsis was evaluated after major elective procedures. Esophageal, pancreatic, and gastric procedures represented the greatest risk for the development of sepsis while thoracic, adrenal, and hepatic procedures accounted for the greatest mortality rates after sepsis developed. Secondary factors associated with developing postoperative sepsis included race, gender, hospital size, hospital location, and patient income.

*The Surgical Outcomes Research Group, Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ;

Division of General Internal Medicine, University of Medicine and Dentistry, Robert, Wood Johnson Medical School, New Brunswick, NJ.

Reprints: Todd R. Vogel, MD, MPH, Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical, School, One Robert Wood Johnson Place, MEB-541, New Brunswick, NJ 08903. E-mail: ...

Supported in part by the American Heart Association ID: 0980011N (to T.R.V.) and the National Institute of General Medical Sciences: RO1 GM 34695 (to S.F.L.).

© 2010 Lippincott Williams & Wilkins, Inc.