Obesity Surgery

, Volume 14, Issue 1, pp 107–115 | Cite as

Use of Drotrecogin Alfa (Activated) in Bariatric Surgery Patients with Severe Sepsis Syndrome: Experience in an Urban Community Teaching Hospital

  • Richard H Savel
  • Ravi C Pulipati
  • Connie Mangone-Cholewczynski
  • Richard S Lazzaro
  • Jerzy M Macura
  • Herbert E Lehman
Article

Background: Severe sepsis syndrome (SSS) and septic shock have an associated mortality ranging from 31 to 60%. Drotrecogin alfa (activated), activated protein C (APC), has been shown in a recent trial to decrease mortality from 44 to 31% in patients with SSS and a high risk of death. We present 3 patients who developed SSS after bariatric surgery and were treated with APC as part of comprehensive therapy for sepsis. Methods: At our institution, patients must have SSS plus an APACHE II score ≥ 25 in order to receive APC. JL is a 43-year-old man who developed SSS (APACHE II score 26) after Roux-en-Y gastric bypass. ML is a 33-year-old man who developed SSS (APACHE II=28) because of a distal obstruction 2.5 years after gastric bypass surgery. TQ was a 35-year-old man who developed SSS (APACHE II=35) in the setting of laparoscopic banding. Results: After receiving 90% of the 96-hour infusion, JL developed ecchymoses and a decrease in his platelet count; thus, the drug was stopped. ML received a full 96-hour infusion. Both patients made a full recovery from their SSS and were successfully discharged from the hospital. TQ developed septic shock and expired despite all efforts. Conclusion: Weight alone should not be considered a contraindication to the use of APC. Close coordination between the intensivist and surgeon is recommended for bariatric surgery patients with SSS, so that a rapid determination can be made as to the patient's risk of death and eligibility to receive APC.

Severe sepsis syndrome activated protein C drotrecogin alfa morbid obesity bariatric surgery anastomotic leak 

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Copyright information

© Springer 2004

Authors and Affiliations

  • Richard H Savel
    • Ravi C Pulipati
      • Connie Mangone-Cholewczynski
        • Richard S Lazzaro
          • Jerzy M Macura
            • Herbert E Lehman

              There are no affiliations available

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