Sepsis in the postoperative period of cardiac surgery: problem description

Abstract

Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high.

Objective: To assess the prevalence, in-hospital evolution and prognosis of patients that presented sepsis in the postoperative period of cardiac surgery.

Methods: This is a prospective study that included patients (n = 7,332) submitted to cardiac surgery (valvular or coronary) between January 1995 and December 2007. The classic criteria of sepsis diagnosis were used to identify the patients that developed such condition and the preoperative comorbidities, in-hospital evolution and prognosis were evaluated.

Results: Sepsis occurred in 29 patients (prevalence = 0.39%). There was a predominance of the male when compared to the female sex (79% vs. 21%). Mean age was 69 +/- 6.5 years. The main preoperative comorbidities were: systemic arterial hypertension (79%), dyslipidemia (48%) and family history of coronary artery disease (38%). The mean Apache score was 18 +/- 7, whereas the Sofa score was 14.2 +/- 3.8. The primary infectious focus was pulmonary in 19 patients (55%). There were 19 positive cultures and the mean IV hydration during the first 24 hours was 1,016 +/- 803 ml. The main complications were acute renal failure (65%), low cardiac output syndrome (55%) and malignant ventricular arrhythmia (55%). Mortality was 79% (23 patients).

Conclusion: The occurrence of sepsis after cardiac surgery was a rare event; however, its occurrence showed catastrophic clinical outcomes. The high morbidity and mortality showed the need to improve treatment, aiming at patients' better clinical evolution.