Infectious complications and mortality in an American acute care surgical service

Abstract

Background: Acute care surgery (ACS) services have evolved in an effort to provide 24-h surgical services for a wide array of general surgical emergencies. The formation of ACS services has been shown to improve outcomes and lead to more expeditious care. Despite the advances of ACS, the etiology and timing of patient mortality has yet to be described. We hypothesized that infectious complications occur more frequently in ACS patients that die during their hospitalization. Methods: A retrospective review of a local ACS service (non-trauma) registry was conducted. Demographic variables, admission and discharge data, and ICD-9 codes were collected. ICD-9 codes were used to identify patients with sepsis, shock, GI perforation, peritonitis, and other hospital acquired infections (urinary tract, bloodstream, and ventilator-associated pneumonias). Univariate and multivariate logistic regression analysis was performed to model the outcome of death. Results: 1,329 patients were analyzed. 53 % were male with the mean age of 52 years and an average length of stay of 13 days. 106 (8 %) died while in the hospital. Of the patients who died, 34 (32 %) died within 7 days of admission. The majority of mortalities (56 %) occurred after hospital day 14. In ACS patients that died, there were significantly higher rates of sepsis, shock, peritonitis, urinary tract infections, and VAP. After adjustment; age, sepsis on admission, and shock on admission were associated with greater odds of death. Conclusion: ACS patients with sepsis and shock have higher mortality rate than those patients without. The majority of ACS patient deaths occurred after hospital day 14. Further investigation and continued focus on preventing and rapidly treating infectious complications as they arise is warranted.