Postsurgical Septic Shock – A Killer

As medical students we were taught about the major lethal complications of surgery – pulmonary embolism and heart attack (myocardial infarction).  These have been greatly reduced in likelihood over the last 50 years, largely by improvements in pre-operative cardiovascular assessment, shorter and lighter anesthesia, and early post-operative mobilization.  Fifty years ago postoperative surgical wound infection was not common – surgical technique and aseptic wound care saw to that.  (Surgeons washed their hands before being allowed by the head nurse to ‘take a peek’ at the stitch line.)  All that has changed in recent years.  A study reported in the Archives of Surgery shows that mortality from septic shock after general surgery is now almost 10-times more frequent than that from pulmonary embolism or myocardial infarction.

The study was done by physicians at thee Methodist Hospital in Houston, Texas.  Using national data, they obtained rates of postsurgical sepsis and subsequent septic shock on over 350,000 patients undergoing general surgery between 2005 and 2007.  They compared those rates with those of the two other complications - pulmonary embolism and heart attack - that have been used to measure quality of care.

The rates of sepsis (2.3%) and septic shock (1.6%) were much higher than those of pulmonary embolism (0.3%) and heart attack (0.2%). Thirty-day mortality rates for each complication were: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32% for heart attack.   Sepsis and septic shock risks were highest in the over-60s, those having emergency surgery, and those with other health problems (diabetes etc). 

It’s clear that hospitals need to identify at-risk patients earlier, institute sepsis screening, and speedily determine the most specific treatment possible.  A very simple screening method would be regular checking of heart rate, temperature, respiratory rate, and white blood cell count;  this can be done at the bedside, as often as necessary.  Avoidance of septic shock is paramount, obviously.