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Sepsis in surgical inpatients: under-recognised but with significant consequences

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.

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Data availability

Data is available upon request.

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Acknowledgements

We would like to thank the staff and patients in the surgical ward in which this study took place, without whom this study would not be possible. Specific thanks to Ms. Yvonne Downey, Clinical Nurse Manager, and Ms. Breffni Smith, Royal College of Surgeons in Ireland (RCSI) Library. We would like to thank the RCSI Research Summer School for their support and the Health Research Board (HRB) for providing the funding for AR to perform this project.

Funding

AR was supported by the Irish HRB Summer Studentship Grant 2018 (grant number: SS-2018-068).

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Correspondence to Aoife Reilly.

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HH has recently received research funding from Pfizer and Astellas and has received a professional fee from Pfizer. All the other authors declare that they have no conflicts of interest.

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Reilly, A., Ali, A.B., Skally, M. et al. Sepsis in surgical inpatients: under-recognised but with significant consequences. Ir J Med Sci 190, 763–769 (2021). https://doi.org/10.1007/s11845-020-02387-0

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  • DOI: https://doi.org/10.1007/s11845-020-02387-0

Keywords

  • Frailty
  • General surgery
  • Sepsis
  • Surgical inpatients