Sepsis: A Surgeon’s Perspective

By Lillian Erdahl, MD

Around 1.5 million people suffer from sepsis and at least 250,000 die due to it each year in the United States. The majority of these individuals-7 out of 10-were recently treated in a healthcare setting and many of them have chronic diseases requiring frequent medical treatment.¹ As a surgeon, I have witnessed how rapidly the process of sepsis can overwhelm a patient’s organ systems. Early, aggressive treatment of the infection and supportive care of the patient is not always enough to reverse the cascade of organ failure leading to death.

Watching a person get sicker despite doing everything you know how to do is both humbling and incredibly disheartening. With all the advanced technology and modern precision medicine we have, we are still fighting single-celled organisms that can kill us from within. I imagine all healthcare providers feel the pain of being unable to successfully intervene against a deadly disease. It never gets easier for me to tell a family that their loved one is getting sicker even though I am doing everything I can to treat his or her illness.

September is Sepsis Awareness Month which is a good time to talk about what we can do to prevent sepsis and sepsis-related mortality.

1. Infection Prevention: A number of interventions in both healthcare and domestic settings can help with infection prevention. Basic hand-washing with soap and water prevents the spread of infectious agents from one individual to another. In the hospital, a number of interventions have been shown to reduce infections including central line catheter insertion protocols. Surgeons are often making decisions about when to insert and remove central venous or urinary catheters. We must recognize and commit to preventive measures each time we interact with a patient.
2. Early Recognition of Sepsis: Recognizing sepsis early is the first step to early treatment. Early signs and symptoms include fever, chills, tachycardia, confusion, and shortness of breath. Patients who are immunocompromised may not manifest typical signs and symptoms, so a high index of suspicion is an important part of identifying sepsis in these high-risk patients.
3. Early Goal-Directed Therapy of Sepsis: Early recognition must be followed by early goal-directed therapy in order to impact the mortality related to sepsis, especially in cases of severe sepsis and septic shock. There have been many studies of how exactly to manage sepsis and septic shock, but it is clear that early antibiotics, source control, and supportive therapies directed at maintaining perfusion and oxygenation improve mortality.²
4. Education of Health Care Providers and the Public: The aim of Sepsis Awareness Month is to drive ongoing discussion and education on many levels. The CDC has a campaign which includes education on how to prevent, recognize, and treat sepsis. You can visit their website for resources that might be helpful during the month.³

References
1. Sepsis. Centers for Disease Control and Prevention https://www.cdc.gov/sepsis/index.html
2. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377
3. Getting Ahead of Sepsis. https://www.cdc.gov/sepsis/get-ahead-of-sepsis/index.html

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Lillian Erdahl practices Breast and General Surgery at the University of Iowa Hospitals and Clinics where she is an Assistant Professor of Surgery as well as the Iowa City VA Medical Center. Her career pursuits include medical student and surgical education as well as improving breast cancer prevention and diagnosis. She enjoys cross-country skiing, yoga, cooking, gardening, and traveling with her husband and two children.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.