Identifying Symptoms and Diagnosing Sepsis After Surgery

You May Be Surprised by the Nonspecific Symptoms of Sepsis

Surgeon preparing for surgery
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Sepsis is life-threatening organ dysfunction that occurs when a person responds to infection in an abnormal, dysregulated manner. Sepsis is a major cause of death in the United States, and postoperative sepsis, meaning the development of sepsis after surgery, accounts for about 30 percent of all these sepsis cases. 

What is Sepsis?

Sepsis is a medical condition where an infection enters the bloodstream, spreads throughout the body, and the body reacts by manifesting a strong inflammatory response.

Sepsis typically starts with a small infection, often one that seems very minor or even goes unnoticed, but progresses quickly. For this reason, all infections, even ones that do not seem important, should be taken seriously, as sepsis is a major potential complication of surgery.

When untreated, or if it doesn't respond to treatment, sepsis can lead to septic shock. Septic shock is even more serious than sepsis and can also result in death. With septic shock, the patient becomes very unstable, with great difficulty maintaining their blood pressure and other issues that can lead to organ failure.

What are the Potential Signs and Symptoms of Sepsis?

While some of the signs of sepsis are similar to what people experience with the flu, such as the chills and a fever, the flu does not typically cause the vast majority of the symptoms present with sepsis.

You may be surprised by some of the  signs and symptoms of sepsis, as they are not always obvious and don't seem related to your surgery.

They include:

  • Chills
  • Altered mental status (confusion)
  • Low body temperature or high body temperature (fever)
  • Low urine output
  • Rapid heart rate (called tachycardia)
  • Rapid breathing rate (called tachypnea)
  • Feeling of lightheadedness
  • Rash
  • Low blood pressure (called hypotension)
  • Skin may feel very warm
  • Weakness
  • Signs specific to the infection source (e.g. cough with sputum if a person has pneumonia or redness and tenderness at the surgical incision site)

    How A Doctor Will Test For Sepsis

    If a doctor suspects sepsis, he will order a number of tests to better evaluate the infection. Some of these tests include blood cultures to determine if there is bacteria present and a variety of blood tests to determine how well your organs are working. For example, in sepsis, a complete blood count (CBC) may reveal lower than normal platelets, a higher or lower than normal white blood cell count (your infection-fighting cells), and the presence of immature white blood cells, called bands. A kidney function blood test may reveal elevated BUN and creatinine levels, indicating that the kidneys are not functioning as well as they should. Lactate levels are also typically elevated in the presence of sepsis. Your doctor may also perform a blood test at your bedside called an arterial blood gas -- this can reveal a metabolic acidosis in the blood, which can be caused by infection. 

    Who is Most at Risk for Developing Sepsis After Surgery?

    According to a 2010 study in the Annals of Surgery, the surgeries that pose the greatest risk for developing sepsis include surgery that involves the esophagus, pancreas, and gastric procedures (like gastric bypass).

    But death for patients who develop postoperative sepsis is highest in surgeries that involve the liver, the chest cavity (e.g. lobectomy to remove part of a lung) or adrenal gland ( a gland that sits upon the kidney). 

    The study also found that patients who are older, male, and non-Caucasian may also be more likely to develop sepsis after elective surgery -- meaning surgery that is not a medical emergency (like an emergent appendectomy to remove an infected appendix). 

    The Bottom Line

    Sepsis is life-threatening, and for the best possible outcome, early detection and treatment is absolutely essential. Do not rule out the possibility of sepsis just because you are unaware of an infection. Some infections are not obvious, such as a kidney infection, or a boil on the skin where it cannot be easily seen. Some people who become septic, did not even know they had an infection.

    Sources:

    Sepsis. The New York Times Health Guide. Accessed March, 2011. http://health.nytimes.com/health/guides/disease/sepsis/overview.html

    Sepsis and Septic Shock. Merck Manual of Medical Information, 2nd Home Edition. Accessed March, 2011. http://www.merckmanuals.com/home/print/sec17/ch191/ch191c.html

    Septicemia. PubMed Health. Accessed March 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002331/

    Singer, M., et al. (2016). The Third International Consensus Definitions for Sepsis and Spetic Shock (Sepsis-3). JAMA. Feb23;315)8):801-10. 

    Vogel, T.R., Dombrovskiy, V.Y., Carson, J.L., Graham, A.M., & Lowry, S.F. (2010). Postoperative sepsis in the United States. Annals of Surgery, Dec;252(6):1065-71. 

    DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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