European Journal of Cardiovascular Medicine

Preventing postoperative sepsis, a hazardous and possibly deadly complication, is a major issue in surgical practice, especially following emergency abdominal surgeries. Sepsis is a systemic inflammatory response to infection that can lead to organ failure, septic shock, and, in severe cases, death. Patients undergoing surgery remain at heightened risk for postoperative sepsis, which extends their hospital stay and elevates their mortality risk, despite advancements in surgical techniques, anesthesia, and antibiotic therapy [1-3].
Emergency abdominal surgery has a higher risk of postoperative sepsis than elective surgery. The primary reasons for this higher risk are delays in getting to the hospital, not enough preoperative resuscitation, having other health problems, unstable blood flow, and contamination of the abdomen during surgery. Patients are at heightened risk of infection and sepsis due to bacterial translocation and contamination of the peritoneal cavity in prevalent emergency abdominal conditions, including perforated peritonitis, intestinal blockage, acute appendicitis, and traumatic bowel injuries [4-6].
During the postoperative phase, infections in the abdominal cavity, wounds, anastomotic leaks, or bacterial proliferation may result in septicemia and sepsis. It is important to quickly diagnose and treat postoperative sepsis to avoid multi-organ failure and high death rates. Older age, diabetes mellitus, anemia, a long surgery, and a high level of contamination are all things that make postoperative infections more likely to happen [7, 8].
Postoperative sepsis is a prevalent and severe complication following emergency abdominal surgeries; however, there is insufficient region-specific evidence concerning its incidence and contributing variables. A better understanding of these things can lead to better surgical results, better care before and after surgery, and the creation of prevention measures [9]. Consequently, researchers at a tertiary care hospital endeavored to quantify the incidence of postoperative sepsis following emergency abdominal procedures and to investigate its etiology, symptoms, prognosis, and microbiological spectrum.

This prospective observational study was conducted in the Department of General Surgery, Dr. Patnam Mahender Reddy Institute of Medical Sciences (PIMS), Chevella, Rangareddy, Telangana between April 2024 to March 2025. A total of 60 patients who underwent emergency abdominal surgeries were included in the study after obtaining informed written consent. The study protocol was approved by the Institutional Ethics Committee prior to commencement.

Inclusion Criteria:

• Patients aged 18 years and above.
• Patients undergoing emergency abdominal surgeries (e.g., perforation peritonitis, intestinal obstruction, acute appendicitis, traumatic bowel perforation).
• Patients who provided informed written consent.

Exclusion Criteria:

• Patients undergoing elective abdominal surgeries.
• Patients with pre-existing sepsis or septic shock before surgery.
• Patients with immunosuppressive disorders.
• Patients with chronic liver disease or end-stage renal disease.
• Patients who refused participation or were lost to follow-up within 30 days post-surgery

This study comprised 60 individuals who had emergency abdominal surgery. In order to detect sepsis or any problems, patients were monitored for 30 days after surgery. Postoperative sepsis developed in 13 out of 60 patients, or 21.7% of the total. Below this, you will find five tables including descriptive analysis of the results.

Table 1: Demographic distribution of patients

The mean age of the patients was 44.8 years, with a male predominance (63.3%). Septic patients were significantly older (p = 0.021) and had a longer mean hospital stay (13.6 days vs. 7.8 days, p < 0.001).

Table 2: Distribution of cases according to surgical diagnosis

Acute appendicitis(25%), intestinal blockage(20%), and perforated peritonitis(45%) were the most common reasons for emergency abdominal surgery. Patients suffering from perforated peritonitis had the greatest rate of postoperative sepsis, at 29.6%.

Table 3: Association of comorbidities with postoperative sepsis

Significant risk factors for the development of postoperative sepsis were revealed to be diabetes mellitus and hypotension at admission (p = 0.02 and p = 0.011, respectively). Anemia and hypertension, two other comorbidities, failed to demonstrate a statistically significant correlation.

Table 4: Operative parameters and intraoperative findings

Postoperative sepsis was associated with considerably longer operating times, increased intraoperative contamination, and higher blood loss in patients (p < 0.05 for all these factors). Moderate to severe contamination was present during surgery for most septic patients.

Table 5: Microbiological profile of septic patients

Escherichia coli was identified from wound or blood cultures at a rate of 46.1%, with Klebsiella pneumoniae coming in at a close second at 30.8%. The contamination pattern typical of abdominal infections was characterized by the predominance of Gram-negative organisms.

Postoperative sepsis was 21.7% in this research of 60 patients having emergency abdominal operations; this is consistent with ranges of 15-30% in other studies that looked at comparable populations (Gupta et al., 2013; Bhattacharjee et al., 2014). This emphasizes the fact that postoperative sepsis is still a leading cause of death in instances involving emergency surgery, particularly in settings where comorbidities, delayed presentation, and contamination are prevalent [10-12].
In this current study the demographic profile showed that older patients had substantially greater rates of sepsis, and that there were 63.3% more males than females. The average age was 44.8 years. Both Mazuski et al. (2015) and Kumar et al. (2012) found that getting older is a risk factor in and of itself, because of the changes in immunological response and the decline in physiological reserve [13-14].
In this current study found that sepsis occurred most frequently in cases of perforated peritonitis (45%) and that this condition was the leading cause of surgical intervention (29.6%). Major peritoneal infection, postponed presentation, and systemic inflammatory reaction before surgery are the possible causes of this. Possible causes of the 25% sepsis risk in cases of intestinal blockage include gut ischemia and bacterial translocation. Kumar et al. (2012) and Tripathi et al. (2013) also discovered that obstruction and peritonitis were the main causes of postoperative sepsis in emergency laparotomies. Our results are similar to theirs [15, 16].
In the previous study, postoperative sepsis was significantly predicted by diabetes mellitus (p = 0.02) and hypotension (p = 0.011) among the comorbidities. Low blood pressure decreases blood flow to tissues, making them more susceptible to infection and organ failure, and inadequate regulation of blood sugar hinders the function of white blood cells and the healing process. Cheadle (2006) and Bhattacharjee et al. (2014) both found that metabolic and circulatory disturbances were major risk factors for infections that could occur after surgery [18, 19].
In the previous study, the onset of sepsis was influenced by factors that occurred during the operation itself. The higher surgical difficulty and contamination risk were reflected in the significantly longer mean operative time (142.5 ± 36.2 minutes) compared to non-septic patients (98.4 ± 28.7 minutes, p = 0.001). Also, postoperative sepsis was significantly related with moderate to severe intraoperative contamination (p = 0.003). The degree of intra-abdominal contamination is directly proportional to postoperative septic problems, as highlighted by Mazuski et al. (2015) and Owens & Stoessel (2008). This conclusion lends credence to their findings [20, 21].
In the previous study, septic patients' microbiological profiles revealed a preponderance of Gram-negative bacteria, with Escherichia coli (46.1%), Klebsiella pneumoniae (30.8%), and Staphylococcus aureus (15.4%) being the most prevalent isolates. This pattern is in line with what is expected of the flora within the abdominal cavity and is in agreement with what has been found in previous studies on postoperative infections after abdominal surgery (Gupta et al., 2013; Mazuski et al., 2015) [22, 23].
The serious clinical impact of this complication was demonstrated by patients who acquired sepsis, who had considerably longer hospital admissions (mean 13.6 ± 4.2 days) and higher fatality rates (15.4%). According to Bhattacharjee et al. (2014), patients with postoperative sepsis had a death rate ranging from 12 to 18%. These results are consistent with that report [23, 24].

Overall, the present study found that 21.7% of patients who had emergency abdominal procedures ended up with postoperative sepsis, which is a major and avoidable cause of death and disability. Severe intra-abdominal contamination, advanced age, diabetes mellitus, hypotension at admission, and a lengthy duration of surgery were all significantly linked to the development of sepsis. The majority of surgical site infections were caused by Gram-negative bacteria, including Klebsiella pneumoniae and Escherichia coli, with perforation peritonitis being the most prevalent surgical site infection resulting to sepsis. This consequence had a devastating effect on patient outcomes, as patients who acquired sepsis had a considerably longer hospital stay and a higher fatality rate (15.4%). Reducing the incidence of postoperative sepsis requires expert surgical technique, stringent aseptic measures, appropriate preoperative resuscitation, careful antibiotic usage, and early identification of high-risk patients. Additional improvement in survival rates can be achieved with continuous postoperative monitoring and timely care in accordance with Sepsis-3 recommendations.

Funding

None

Conflict of Interest:

None.

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