Surgery News - October 2008 - (Page 16)

16 POSTOP MANAGEMENT SURGERY NEWS • O C T O B E R 2 0 0 8 Data Show Rise in Postoperative Sepsis Rates B Y E L I Z A B E T H M E C H C AT I E Else vier Global Medical Ne ws T he rate of postoperative sepsis among adult patients increased significantly over a 17-year period, as did the proportion of cases that were considered severe, according to an analysis of a state inpatient database. Although hospital mortality from postoperative sepsis dropped in patients undergoing nonelective surgery, the proportion of patients who developed severe sepsis following elective surgery increased significantly, and mortality from sepsis after elective surgery did not improve, according to Dr. Todd Vogel. He presented results of the study at the annual meeting of the Surgical Infection Society. “What’s concerning from the data is that elective cases did not show a significant decreased trend at all; in fact, we have not made any headway in mortality secondary to sepsis” after elective surgery, said Dr. Vogel of the Robert Wood Johnson Medical School, New Brunswick. Dr. Vogel and his associates analyzed data from the State Inpatient Database for New Jersey from 1990 to 2006 for patients aged 18 and older who developed sepsis after elective or nonelective surgery, using diagnosis codes defined by the Agency for Healthcare Research and Quality. There were 1,276,451 surgery discharges during that time, of which 42% were elective and 58% were nonelective. Sepsis was a complication in 3% of all surgical procedures. Of the patients having elective surgery, reduced minimum investment WE SHRUNK THE MINIMUM about 1% developed postoperative sepsis and 0.5% developed severe sepsis (defined as sepsis complicated by organ dysfunction). The rate of sepsis after elective surgery rose from 0.67% to 1.74%, and the rate of severe sepsis increased from 0.22% to 1.12%. Both were highly statistically significant increases. The proportion of sepsis cases that were severe after elective surgery nearly doubled from 33% to 65%, also a highly significant increase. The rates of postoperative sepsis and severe sepsis were significantly higher among the patients who had nonelective surgery (about 4% for sepsis and about 2% for severe sepsis). The rate of sepsis after nonelective surgical procedures increased from 3.7% to 4.5%, and the rate of severe sepsis increased from 1.8% to about 3%. The proportion of sepsis cases after nonelective surgery that were severe increased THE RATE OF SEPSIS AFTER NONELECTIVE SURGERY ROSE FROM 3.7% TO 4.5%, AND THE RATE OF SEVERE SEPSIS GREW FROM 1.8% TO ABOUT 3%. significantly from almost 48% to nearly 70%. However, in-hospital mortality among these patients dropped from 38% to 30% for sepsis and from 55% to 38% for severe sepsis, a highly significant decrease. The pattern of pathogens also changed during the period studied, with a significant drop in rates of septicemia caused by staphylococci, anaerobes, pseudomonas, and Escherichia coli among the nonelective surgery cohort. There was also a significant increase in the rates of streptococcal septicemia and staphylococcal septicemia in a subgroup of patients undergoing elective surgery, but the rates of septicemia caused by E. coli, pseudomonas, and anaerobes remained unchanged in this cohort. The findings may be explained by changes in the types of patients who are admitted to the hospital for elective surgery, Dr. Vogel said in an interview. The trend toward minimally invasive procedures may mean that elderly or sicker patients are more likely to be admitted to the hospital for elective surgery, he speculated. The improved mortality among nonelective cases could be attributable to advances in critical care and antibiotics, and greater awareness of sepsis, he added, noting that this was not clear from the data and will be the focus of a future study. The investigators also found a significant disparity based on ethnicity, sex, and age of patients, which Dr. Vogel said needs to be studied further. The rates of postoperative sepsis and mortality after nonelective and elective surgery were highest among black patients, compared with white patients (who had the lowest rates) and Hispanic patients. Men were more likely to have postoperative sepsis than were women, and there was a significant increase in the rates of postoperative sepsis with age. ■ The suggested minimum investment to participate in SDIF has been reduced to $10,000. For those who ﬁnd it appropriate to participate in an automatic investment plan1, the minimum initial investment is $5,000 assuming an automatic investment plan of at least $100 per month is implemented; waivers of the minimum are possible. The minimum investment has been modiﬁed for Medical Student Members ($500), Resident Members ($1,000), and Associate Fellows ($2,500) of the College. For more information about SDIF or regarding the waived minimum, please contact Savi Pai, 312/202-5056 or spai@facs. org, or Tom Kiley, 312/202-5019 or tkiley@facs.org. Both are available to discuss speciﬁc details regarding SDIF. You may also visit the Web site at www.surgeonsfund.com or call 800/208-6070. An investor should consider the investment objectives, risks, and charges and expenses of SDIF carefully before investing. SDIF’s prospectus contains this and other information about SDIF and should be read before investing. SDIF’s prospectus may be obtained by downloading it from SDIF’s Web site at www.surgeonsfund.com or by calling 800/208-6070. ¹A program of regular investing does not ensure a proﬁt or protect against depreciation in a declining market. Because a consistent investing program involves continuous investment in securities regardless of ﬂuctuating prices, you should consider your ﬁnancial ability to continue to purchase through periods of various price levels. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246. The phone number is 513/587-3400. http://www.surgeonsfund.com http://www.surgeonsfund.com http://www.surgeonsfund.com

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Surgery News - October 2008 Contents Call to Action Issued to Support DVT, PE Prevention Protocol Changes May Increase Donor Organs CMS Targets 2011 for Switch to ICD-10 Opinion: Election 2008 The 20/20 Vision: Children's Health News From the College: Survival Strategy General Surgery: Innovations

Surgery News - October 2008

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