POST-OPERATIVE SEPSIS AND SEPTIC SHOCK IN OBSTETRIC SURGERY & GENERAL SURGERY PATIENTS; MICROBIOLOGICAL PROFILE OF THE BACTERIAL ISOLATES.
Main Article Content
Keywords
post operativ, sepsis, septic shock, surgery
Abstract
Background
Sepsis and Septic shock manifest as multiple organ failure and are major cause of morbidity and mortality globally. Sepsis and septic shock are major complications leading to mortality post-operatively in the intensive care unit. The aim of present study is to study the incidence, risk factors, mortality rate, for sepsis and septic shock in emergency obstetric and general surgeries post-operatively.
Methods
The study is a record based cross sectional study design. The medical records of patients who underwent emergency obstetric and general surgery in a Tertiary care centre, South India were evaluated from the year July 2020 to August 2023.
Results
There was a total of 1459 patients who underwent emergency surgeries, out of which 945 were emergency obstetric surgeries and 514 were emergency general surgeries. Of the emergency obstetric surgeries 79(8.35%) patients had sepsis and 49(5.18%) had septic shock. Whereas 51(9.92%) patients had sepsis and 36(7%) patients had septic shock in the emergency general surgery group. The in-hospital mortality for obstetric group was 44.89% for septic shock and 18.98% for sepsis and for surgery group 54.9% for septic shock and 30.61% for sepsis. The risk of sepsis and septic shock was higher in patients older than 60 years in the surgery group (OR: 2.5, 95% Confidence Interval 2.3-2.7) and age more than 35 years in the obstetric group (OR: 1.8, 95% Confidence interval 1.7-1.9). The presence of comorbidity increased risk of sepsis and septic shock 3 fold (OR= 3.1, 95%Confidence Interval, 2.8-3.4) in obstetric group and 5 fold(OR= 5.3, 95%Confidence Interval, 1.8-14.5) fold in general surgery group. There was significant difference in the incidence of sepsis and septic shock between general surgery and obstetric surgery patients, X2 (1, N = 1459) = 9.33, p =.002. General Surgery patients were more likely to have sepsis than the obstetric surgery patients postoperatively. In-hospital mortality also showed difference between the two groups, X2(1, N =1459) = 12.72, p <.001. General Surgery patients had more in-hospital mortality than the obstetric surgery patients. Staphylococcus aureus (40%) was predominant pathogen and least was Enterococcus spp (2.8%).
Conclusion
The incidence of sepsis and septic shock post operatively following general surgery is higher than the obstetric surgery. The in-hospital mortality is also higher in emergency general surgery patients with sepsis and septic shock compared to emergency obstetric surgery patients post-operatively. Patients with comorbidities who had either of the surgeries were more likely to have sepsis, septic shock and mortality post-operatively. Advanced age also increases the likelihood of sepsis and septic shock. Early recognition of perioperative complications, warning signs and prompt management with evidence-based guidelines is imperative for better outcomes post-operatively.
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Dr. Shreyas Gomedic Ramachandra
Assistant Professor, Department of Anesthesiology, Sri Chamundeshwari Medical College and Research Institute, Channapatna, Ramanagar, Karnataka, India.
Dr. Bewin Oral. J
Associate Professor, Department of Microbiology, Sree Uthradom Thirunal Academy of Medical Sciences, Vencode, Thiruvananthapuram, Kerala, India.
Dr. Goldy S.J
Associate Professor, Department of Obstetrics and Gynaecology, Sree Uthradom Thirunal Academy of Medical Sciences, Vencode, Thiruvananthapuram, Kerala, India
Dr. Gnananjali A.R.
Assistant Professor, Department of Microbiology, St. Peter's Medical College and Research Institute, Hosur, Tamil Nadu, India.