Sepsis is a severe medical emergency arising from the body’s overwhelming and life-threatening response to an infection. Instead of effectively fighting off harmful germs, the immune system overreacts, leading to widespread inflammation that can damage tissues and organs throughout the body. Without urgent medical intervention, sepsis can rapidly progress, potentially leading to organ failure and even death.
Understanding Sepsis After Surgery
When an infection triggers this systemic response, it can cause damage to normal tissues and organs. An abnormal chain reaction in the clotting system can also occur, leading to blood clots that reduce blood flow and oxygen to vital organs.
Surgery increases the risk of sepsis due to several factors. Surgical incisions, for instance, create openings in the skin, which normally acts as a protective barrier, providing potential entry points for bacteria. Internal procedures can also expose sterile body cavities to bacteria, particularly in cases involving the bowel where bacteria can spill into the abdominal cavity.
The body’s immune system undergoes significant changes following surgery. The trauma from an operation triggers a complex immune response, which can initially involve a systemic inflammatory reaction. This is often followed by a period of immunosuppression, where the immune system’s ability to fight off new infections is reduced, making the patient more vulnerable to developing sepsis. Medical devices like catheters or drains, though inserted with sterile techniques, break the skin barrier and can serve as pathways for infection. Patients with pre-existing health conditions or those undergoing extensive or emergency surgeries also face an elevated risk.
When Sepsis Can Occur
Sepsis can develop any time an infection takes hold, but the risk is highest in the days to weeks immediately following a surgical procedure. While a common operation carries a low risk, affecting up to 1% of patients, emergency surgeries or major abdominal procedures, such as those for bowel conditions, can increase the risk to 5-10%.
The timeframe for sepsis onset is influenced by the type and location of the infection. Surgical site infections, pneumonia, or urinary tract infections are common sources of post-operative sepsis. For example, reduced mobility after surgery can lead to chest infections, which may progress to pneumonia and subsequently sepsis. Catheterization during or after surgery can also increase the risk of urinary tract infections, especially the longer the catheter remains in place.
Sepsis can manifest rapidly, sometimes within hours, or it can develop over several days or even weeks if an infection persists or emerges later in the recovery period. While the most acute risk is in the immediate post-operative phase, vigilance is important throughout the healing process, particularly for patients with compromised health or delayed wound healing.
Recognizing the Warning Signs
Post-surgical patients and their caregivers should recognize the warning signs of sepsis. Symptoms can sometimes be subtle or mimic normal post-operative recovery, requiring careful observation.
Signs include a high temperature (fever) or, conversely, a low body temperature, chills, and shivering. Other indicators include changes in vital signs such as a rapid heart rate and fast breathing. Neurological changes, including confusion, disorientation, slurred speech, or a decreased level of alertness, are also signs. Patients may also experience extreme pain or discomfort, clammy or sweaty skin, or a rash.
Local surgical site signs, such as increasing redness, warmth, swelling, increased pain, or any discharge like pus from the incision, warrant concern.
Symptoms like reduced urine output, nausea, vomiting, or difficulty breathing indicate a worsening condition. Any combination of these symptoms, especially if accompanied by a recent history of surgery, warrants immediate medical attention.
Steps to Take for Suspected Sepsis
If sepsis is suspected after surgery, seek immediate medical attention, as early intervention improves outcomes. Call emergency services or go to the nearest emergency room without delay. When seeking medical help, clearly communicate that the patient recently had surgery and describe all symptoms observed, along with any current medications.
Upon arrival at a medical facility, healthcare professionals will conduct various tests to confirm infection and assess organ function. Tests may include blood tests for infection signs, organ dysfunction markers, and blood clotting problems. Blood cultures identify the specific bacteria causing the infection, though results can take time. Imaging tests like X-rays, CT scans, or ultrasounds may also be used to locate the source of the infection.
Treatment for sepsis begins promptly, often with broad-spectrum antibiotics administered intravenously to target potential bacteria, even before the specific pathogen is identified. Intravenous fluids are given to maintain blood flow and prevent blood pressure from dropping too low. Depending on the severity, other supportive care such as vasopressor medications to increase blood pressure, oxygen therapy, or even mechanical ventilation for breathing support may be required, often in an intensive care unit. In some cases, surgery may be required to remove infected tissue or drain abscesses.