The Management and Outcomes of Surgical Sepsis in Limiting Resource during COVID-19 Pandemic

Abstract

Background: Sepsis is a life-threatening organ dysfunction caused by the dysregulated host response to infection. Surgical sepsis is a form of sepsis that requires source control. Treating surgical sepsis patients during the COVID-19 pandemic presented several limitations, particularly in terms of source control. Objective: To evaluate the management of surgical sepsis patients at Ramathibodi Hospital by comparing outcomes before and during the COVID-19 pandemic. Materials and Methods: Retrospective analysis was conducted on patients diagnosed with sepsis in the Department of Surgery at Ramathibodi Hospital between May 2019 and April 2021. Patients were divided into two groups with Group A that comprised patients diagnosed with sepsis before the COVID-19 pandemic, between May 2019 and April 2020, and Group B that consisted of patients diagnosed with sepsis during the pandemic, between May 2020 and April 2021. Surgical sepsis patients were analyzed to ascertain the mortality rate and conduct multivariate analysis to demonstrate the association of exposure variables with the mortality rate in this group. Results: Two hundred ninety patients were included, with 145 diagnosed with sepsis in both Group A and Group B. Among them, 49 in Group A and 68 in Group B were classified as surgical sepsis. The mortality rate for surgical sepsis patients in Group A and Group B were 26.53% and 33.82%, respectively. The present study showed no significant difference between the two groups regarding mortality (p=0.399). Multivariable analysis revealed that surgical sepsis patients either not admitted to ICU or admitted for less than 15 days had a lower mortality rate (adjusted OR 0.01 and 0.12, respectively) (p<0.001). Conclusion: The limited resources during COVID-19 did not appear to impact the mortality rate of surgical sepsis patients. However, it is crucial to acknowledge that there may be other potential confounding factors that cannot be controlled. The mortality rate may differ in contexts different from the present study.