Aoife Reilly1, Ali Basil Ali2, Mairead Skally3, Leah Gaughan4, Vida Hamilton5, Alexandra Troy6, Hilary Humphreys2,3, Deborah McNamara6, Fidelma Fitzpatrick2,3. 1. Department of Clinical Microbiology, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland. areilly@rcsi.ie. 2. Department of Clinical Microbiology, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland. 3. Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland. 4. Department of Pharmacy, Beaumont Hospital, Dublin 9, Ireland. 5. Department of Anaesthesia & Intensive Care, University College Hospital, Waterford, Ireland. 6. Department of Surgery, Beaumont Hospital, Dublin 9, Ireland.
Abstract
BACKGROUND: The true incidence of sepsis in surgical cohorts in Ireland remains unclear. According to inpatient audits, patients in surgical diagnostic groups (DRG) who developed sepsis had a longer length of stay and higher mortality rate compared with medical DRG patients who developed sepsis. AIMS: We investigated sepsis incidence on a general surgical ward to identify risk factors and strategies to improve management. METHODS: Demographics, admission and discharge details, infection risk factors, infection, and sepsis were studied prospectively on a surgical ward in July 2018. RESULTS: The mean age of 164 patients was 60.5 years (range 18-93 years), 107 (65.2%) were admitted electively, 16 (9.8%) were colonised with a multidrug-resistant organism (MDRO), and 30 (18.3%) were classified as frail on admission. Twelve (7.3%) developed sepsis (ward sepsis rate 118.2/10,000 bed days used). 'Sepsis' was documented in six cases and the national sepsis screening form used in four patients. Patients with sepsis were three times as likely to be MDRO-colonised (OR 3.56; 95% CI = 0.86-14.82; p = 0.065) or frail (OR 3.63; 95% CI = 1.07-12.35; p = 0.03), four times as likely to be an inpatient at the end of the study (OR 4.22, 96% CI 1.23-14.49; p = 0.01), and three times as likely to be readmitted (OR 3.46, 95% CI 1.02-11.76; p = 0.03). CONCLUSION: Sepsis was under-documented, and barriers exist with use of the national sepsis screening form. Frailty, which is a sepsis risk factor, should be assessed pre-operatively to maximise prevention.
BACKGROUND: The true incidence of sepsis in surgical cohorts in Ireland remains unclear. According to inpatient audits, patients in surgical diagnostic groups (DRG) who developed sepsis had a longer length of stay and higher mortality rate compared with medical DRG patients who developed sepsis. AIMS: We investigated sepsis incidence on a general surgical ward to identify risk factors and strategies to improve management. METHODS: Demographics, admission and discharge details, infection risk factors, infection, and sepsis were studied prospectively on a surgical ward in July 2018. RESULTS: The mean age of 164 patients was 60.5 years (range 18-93 years), 107 (65.2%) were admitted electively, 16 (9.8%) were colonised with a multidrug-resistant organism (MDRO), and 30 (18.3%) were classified as frail on admission. Twelve (7.3%) developed sepsis (ward sepsis rate 118.2/10,000 bed days used). 'Sepsis' was documented in six cases and the national sepsis screening form used in four patients. Patients with sepsis were three times as likely to be MDRO-colonised (OR 3.56; 95% CI = 0.86-14.82; p = 0.065) or frail (OR 3.63; 95% CI = 1.07-12.35; p = 0.03), four times as likely to be an inpatient at the end of the study (OR 4.22, 96% CI 1.23-14.49; p = 0.01), and three times as likely to be readmitted (OR 3.46, 95% CI 1.02-11.76; p = 0.03). CONCLUSION:Sepsis was under-documented, and barriers exist with use of the national sepsis screening form. Frailty, which is a sepsis risk factor, should be assessed pre-operatively to maximise prevention.
Entities:
Keywords:
Frailty; General surgery; Sepsis; Surgical inpatients
Authors: Shannon M Fernando; Daniel I McIsaac; Jeffrey J Perry; Bram Rochwerg; Sean M Bagshaw; Kednapa Thavorn; Andrew J E Seely; Alan J Forster; Kirsten M Fiest; Chintan Dave; Alexandre Tran; Peter M Reardon; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Med Date: 2019-08 Impact factor: 7.598