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Rehospitalizations Following Sepsis: Common and Costly.

ABSTRACT: Although recent studies have shown that 30-day readmissions following sepsis are common, the overall fiscal impact of these rehospitalizations and their variability between hospitals relative to other high-risk conditions, such as congestive heart failure and acute myocardial infarction, are unknown. The objectives of this study were to characterize the frequency, cost, patient-level risk factors, and hospital-level variation in 30-day readmissions following sepsis compared with congestive heart failure and acute myocardial infarction.A retrospective cohort analysis of hospitalizations from 2009 to 2011.All acute care, nonfederal hospitals in California.Hospitalizations for sepsis (n = 240,198), congestive heart failure (n = 193,153), and acute myocardial infarction (n = 105,684) identified by administrative discharge codes.None.The primary outcomes were the frequency and cost of all-cause 30-day readmissions following hospitalization for sepsis compared with congestive heart failure and acute myocardial infarction. Variability in predicted readmission rates between hospitals was calculated using mixed-effects logistic regression analysis. The all-cause 30-day readmission rates were 20.4%, 23.6%, and 17.7% for sepsis, congestive heart failure, and acute myocardial infarction, respectively. The estimated annual costs of 30-day readmissions in the state of California during the study period were $500 million/yr for sepsis, $229 million/yr for congestive heart failure, and $142 million/yr for acute myocardial infarction. The risk- and reliability-adjusted readmission rates across hospitals ranged from 11.0% to 39.8% (median, 19.9%; interquartile range, 16.1-26.0%) for sepsis, 11.3% to 38.4% (median, 22.9%; interquartile range, 19.2-26.6%) for congestive heart failure, and 3.6% to 40.8% (median, 17.0%; interquartile range, 12.2-20.0%) for acute myocardial infarction. Patient-level factors associated with higher odds of 30-day readmission following sepsis included younger age, male gender, Black or Native American race, a higher burden of medical comorbidities, urban residence, and lower income.Sepsis is a leading contributor to excess healthcare costs due to hospital readmissions. Interventions at clinical and policy levels should prioritize identifying effective strategies to reduce sepsis readmissions.

SUBMITTER: Chang DW

PROVIDER: S-EPMC5044864 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Rehospitalizations Following Sepsis: Common and Costly.

Chang Dong W DW Tseng Chi-Hong CH Shapiro Martin F MF

Critical care medicine 20151001 10

<h4>Objective</h4>Although recent studies have shown that 30-day readmissions following sepsis are common, the overall fiscal impact of these rehospitalizations and their variability between hospitals relative to other high-risk conditions, such as congestive heart failure and acute myocardial infarction, are unknown. The objectives of this study were to characterize the frequency, cost, patient-level risk factors, and hospital-level variation in 30-day readmissions following sepsis compared wit ...[more]

PMID: 26131597

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Project description:Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7%) and in 79 patients (6.9%), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4%), recurrent chest pain with ischemia and coronary intervention (16.9%), and ischemic events (16.9%). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5%), infections (14.3%), and cancer (9.1%). On multivariate analysis, left ventricular ejection fraction (22% increase in the rate of RHs per 10% decrease; P=0.03) and angiographic myocardial infarction Syntax score (34% increase per 10-point increase; P=0.01) were independent predictors of unplanned cardiac RHs. Age emerged as the only independent predictor of unplanned noncardiac RHs. Regional differences for unplanned cardiac RHs were observed. Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12% with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7% with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00962416.

Project description:Preventing rehospitalizations for patients with serious chronic illnesses is a focus of national quality initiatives. Although 8 million people are admitted yearly to an ICU, the frequency of rehospitalizations (readmissions to the hospital after discharge) is unknown. We sought to determine the frequency of rehospitalization after an ICU stay, outcomes for rehospitalized patients, and factors associated with rehospitalization.Retrospective cohort study using the New York Statewide Planning and Research Cooperative System, an administrative database of all hospital discharges in New York State.ICUs in New York State.ICU patients who survived to hospital discharge in 2008-2010.None.Primary outcome was the cumulative incidence of first early rehospitalization (within 30 days of discharge), and secondary outcome was the cumulative incidence of late rehospitalization (between 31 and 180 d). Factors associated with rehospitalization within both time periods were identified using competing risk regression models. Of 492,653 ICU patients, 79,960 had a first early rehospitalization (cumulative incidence, 16.2%) and an additional 73,250 late rehospitalizations (cumulative incidence, 18.9%). Over one quarter of all rehospitalizations (28.6% for early; 26.7% for late) involved ICU admission. Overall hospital mortality for rehospitalized patients was 7.6% for early and 4.6% for late rehospitalizations. Longer index hospitalization (adjusted hazard ratio, 1.61; 95% CI, 1.57-1.66 for 7-13 d vs < 3 d), discharge to a skilled nursing facility versus home (adjusted hazard ratio, 1.54; 95% CI, 1.51-1.58), and having metastatic cancer (adjusted hazard ratio, 1.46; 95% CI, 1.41-1.51) were associated with the greatest hazard of early rehospitalization.Approximately 16% of ICU survivors were rehospitalized within 30 days of hospital discharge; rehospitalized patients had high rates of ICU admission and hospital mortality. Few characteristics were strongly associated with rehospitalization, suggesting that identifying high-risk individuals for intervention may require additional predictors beyond what is available in administrative databases.

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Rehospitalizations Following Sepsis: Common and Costly.

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Rehospitalizations Following Sepsis: Common and Costly.

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