Postoperative Sepsis in an Upper Gastrointestinal Surgical Ward

Abstract

Degree Project Thesis, Programme in Medicine. TITLE: Postoperative Sepsis in an Upper Gastrointestinal Surgical Ward. Background: Postoperative sepsis constitutes a considerable proportion of surgical healthcare problems and upper gastrointestinal surgery includes high risk procedures. The challenge in early diagnosis of postoperative sepsis is to separate the inflammatory response to surgery from that of an infection, i.e. sepsis. Recent studies suggest risk factors and early markers of postoperative sepsis. Assessment tools for vital signs are used but no established screening tool aimed specifically to identify postoperative sepsis exists. Efforts made to diminish the problems of sepsis focus mainly on severe sepsis and its treatment. When approaching early identification of sepsis the guidelines directs mostly to patients in the ICU, not patients in surgical wards. Objective: To identify possible predicative risk factors for postoperative sepsis and clinical and laboratory parameters useful for early-stage diagnosis of postoperative sepsis. Methods: Data from 50 patients submitted to upper gastrointestinal surgery were prospectively collected at the Haukeland University hospital, Bergen, Norway. The four parameters of the systemic inflammatory response syndrome (SIRS) and CRP were followed daily postoperatively. In order to find possible preoperative and postoperative risk factors for postoperative sepsis logistic regression analysis was performed. Results: The progress of the parameters respiratory frequency, heart rate, body temperature and CRP over the first ten postoperative days turned out to be significant early markers of postoperative sepsis. The incidence of postoperative sepsis in this upper gastrointestinal surgical setting was 16% with a lethal outcome of 25% for the sepsis patients. The sepsis patients were more likely to have a malignancy and they had a longer hospital stay than no-sepsis patients. Conclusions: This study suggests that it is the dynamics of the clinical parameters of SIRS and CRP that are of significant importance when identifying postoperative sepsis. A screening tool for postoperative sepsis should take into account repeated measurements (i.e. abnormal values over time) when alerting for signs of sepsis, rather than one single data gathering.

Key words: Postoperative sepsis, upper gastrointestinal surgery, early diagnosis, SIRS, clinical parameters.