Postoperative Sepsis in the United States
Postoperative Sepsis in the United States
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 development of sepsis creates a substantial health care burden, and limited epidemiologic information exists with regard to postoperative sepsis. Martin et al demonstrated that the incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. The National Healthcare Quality Reports estimated 11.6 cases of postoperative sepsis per 1000 elective surgery discharges with hospital length of stay (LOS) longer than 3 days. Other population studies focusing on elective procedures have demonstrated that the rates of sepsis and severe sepsis have increased significantly over the last decade with little improvement in overall mortality. Sepsis remains one of the leading causes of death in the United States, and surgical patients account for approximately one-third of all sepsis cases.
As payers move toward performance-based reimbursement, evaluation of hospital performance will become more important, and studies focusing on higher risk surgical procedures and best practices to prevent possible complications may offer future targets for intervention. Administrative data offer the ability to evaluate large numbers of interventions, to delineate procedures more prone to complications, and to describe hospital and patient characteristics associated with septic complications after elective surgery.
The objective of this study was to describe the epidemiology of postoperative sepsis in the United States after elective in-patient elective surgery by procedure type. Secondary aims included description of sociodemographic factors and hospital characteristics associated with the development of postoperative sepsis. The identification of high-risk groups may assist in identifying process level opportunities for improvements to reduce the incidence of sepsis.
Abstract and Introduction
Abstract
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.
Introduction
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 development of sepsis creates a substantial health care burden, and limited epidemiologic information exists with regard to postoperative sepsis. Martin et al demonstrated that the incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. The National Healthcare Quality Reports estimated 11.6 cases of postoperative sepsis per 1000 elective surgery discharges with hospital length of stay (LOS) longer than 3 days. Other population studies focusing on elective procedures have demonstrated that the rates of sepsis and severe sepsis have increased significantly over the last decade with little improvement in overall mortality. Sepsis remains one of the leading causes of death in the United States, and surgical patients account for approximately one-third of all sepsis cases.
As payers move toward performance-based reimbursement, evaluation of hospital performance will become more important, and studies focusing on higher risk surgical procedures and best practices to prevent possible complications may offer future targets for intervention. Administrative data offer the ability to evaluate large numbers of interventions, to delineate procedures more prone to complications, and to describe hospital and patient characteristics associated with septic complications after elective surgery.
The objective of this study was to describe the epidemiology of postoperative sepsis in the United States after elective in-patient elective surgery by procedure type. Secondary aims included description of sociodemographic factors and hospital characteristics associated with the development of postoperative sepsis. The identification of high-risk groups may assist in identifying process level opportunities for improvements to reduce the incidence of sepsis.
Source...