CCR - Mar16 Combined.indb

Sepsis is a common post-operative complication, which may account for one-third of all cases of sepsis.1 Patients who develop sepsis during or after surgery can progress to multiple organ dysfunction, and have a signifi cantly greater mortality rate during their hospital stay.2-4 The cost of treating such patients was estimated as three times higher than treating surgical patients without postoperative sepsis.5 Sepsis complicated by organ failure is also responsible for 10%–12% of admissions to intensive care units.6,7 Finally, sepsis-related morbidity appears to have an adverse impact on long-term outcomes after hospital discharge.8 The American Agency for Healthcare Research and Quality (AHRQ) has developed a set of patient safety indicators (PSIs), including for post-operative sepsis (PSI 13), with the aim of detecting preventable hospital complications and adverse events after surgery.9 These indicators are evidence-based measures of patient safety designed for use in administrative databases.10 Over the past decade, this defi nition of post-operative sepsis has been widely used in the United States to measure aspects of patient safety and quality and to monitor the impact of quality improvement initiatives.4,10-13 Based on the AHRQ methodology, the Organisation for Economic Cooperation and Development (OECD) Quality Indicator Project also included post-operative sepsis in its patient safety indicators.14 Despite such large data management initiatives, there are currently no large studies on measuring and reporting the epidemiology of post-operative sepsis in Australia. This is unfortunate because the issue is of major public health interest and because, given the unique aspects of the American health care system, there is uncertainty about the applicability of the US fi ndings in Australia. Our aim was therefore to study the epidemiology of post-operative sepsis and sepsis-related mortality among adult elective surgical patients admitted in all public acute care hospitals between 2002 and 2009 in New South Wales, Australia, using AHRQ methodology.