Epidemiology and Predictors of 30-Day Readmission in Patients With Sepsis.
Aged
Aged, 80 and over
Comorbidity
Diabetes Mellitus
/ epidemiology
Female
Health Services Needs and Demand
Heart Failure
/ epidemiology
Hospital Costs
/ statistics & numerical data
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Patient Readmission
/ statistics & numerical data
Quality Improvement
/ organization & administration
Renal Insufficiency, Chronic
/ epidemiology
Risk Factors
Sepsis
/ diagnosis
United States
predictors
readmission
sepsis
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
23
04
2018
revised:
30
11
2018
accepted:
04
12
2018
entrez:
9
3
2019
pubmed:
9
3
2019
medline:
21
12
2019
Statut:
ppublish
Résumé
Patients with sepsis are particularly vulnerable to readmissions. We describe the associated etiology and risk factors for readmission in patients with sepsis using a large administrative database inclusive of patients of all ages and insurance status. Our study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data from 2013 to 2014 by identifying patients admitted with sepsis. The primary outcome was 30-day readmission with etiology identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes. From a total 1,030,335 index admissions; mean age, 66.8 ± 17.4 years (60% age ≥65 years), 898,257 patients (87.2%) survived to discharge. A total of 157,235 (17.5%) patients had a 30-day readmission; median time to readmission was 11 days (interquartile range, 5-19). Infectious etiology (42.16%; including sepsis, 22.86%) was the most commonly associated cause for 30-day readmission followed by gastrointestinal (9.6%), cardiovascular (8.73%), pulmonary (7.82%), and renal causes (4.99%). Significant predictors associated with increased 30-day readmission included diabetes (OR, 1.07; 95% CI, 1.06-1.08; P < .001), chronic kidney disease (1.12;1.10-1.14, P < .001), congestive heart failure (OR, 1.16; 95% CI, 1.14-1.18; P < .001), discharge to short-/long-term facility (OR, 1.13; 95% CI, 1.11-1.14; P < .001), Charlson comorbidity index ≥ 2, and length of stay ≥ 3 days during the index admission. The mean cost per readmission was $16,852; annual cost was > $3.5 billion within the United States. We describe that readmission after a sepsis hospitalization is common and costly. The majority of readmissions were associated with infectious etiologies. The striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this outcome.
Sections du résumé
BACKGROUND
Patients with sepsis are particularly vulnerable to readmissions. We describe the associated etiology and risk factors for readmission in patients with sepsis using a large administrative database inclusive of patients of all ages and insurance status.
METHODS
Our study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data from 2013 to 2014 by identifying patients admitted with sepsis. The primary outcome was 30-day readmission with etiology identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes.
RESULTS
From a total 1,030,335 index admissions; mean age, 66.8 ± 17.4 years (60% age ≥65 years), 898,257 patients (87.2%) survived to discharge. A total of 157,235 (17.5%) patients had a 30-day readmission; median time to readmission was 11 days (interquartile range, 5-19). Infectious etiology (42.16%; including sepsis, 22.86%) was the most commonly associated cause for 30-day readmission followed by gastrointestinal (9.6%), cardiovascular (8.73%), pulmonary (7.82%), and renal causes (4.99%). Significant predictors associated with increased 30-day readmission included diabetes (OR, 1.07; 95% CI, 1.06-1.08; P < .001), chronic kidney disease (1.12;1.10-1.14, P < .001), congestive heart failure (OR, 1.16; 95% CI, 1.14-1.18; P < .001), discharge to short-/long-term facility (OR, 1.13; 95% CI, 1.11-1.14; P < .001), Charlson comorbidity index ≥ 2, and length of stay ≥ 3 days during the index admission. The mean cost per readmission was $16,852; annual cost was > $3.5 billion within the United States.
CONCLUSION
We describe that readmission after a sepsis hospitalization is common and costly. The majority of readmissions were associated with infectious etiologies. The striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this outcome.
Identifiants
pubmed: 30846065
pii: S0012-3692(18)32895-2
doi: 10.1016/j.chest.2018.12.008
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
483-490Informations de copyright
Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.