Association Between Index Hospitalization and Hospital Readmission in Sepsis Survivors*

Sun, Alexander; Netzer, Giora; Small, Dylan S.; Hanish, Asaf; Fuchs, Barry D.; Gaieski, David F.; Mikkelsen, Mark E.

doi:10.1097/ccm.0000000000001464

Cited by 69 publications

(84 citation statements)

References 30 publications

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“…The relationship between index sepsis hospitalization and unplanned hospital readmissions was demonstrated by Sun et al [24] in a retrospective cohort study in the USA. The study demonstrated that unplanned hospital readmissions after an episode of sepsis are common, and that infection was the commonest reason for readmission.…”

Section: Hospital Readmissionsmentioning

confidence: 99%

“…These studies [10,24] reinforce that more research is necessary to (1) understand better the risk factors associated with readmission after sepsis, (2) identify strategies to decrease the risk of readmission after sepsis, initially with observational cohort studies with propensity matching of readmitted and nonreadmitted patients, and then (3) prospective RCTs of interventions to ultimately define cost-effective interventions in sepsis survivors that decrease readmission rates after hospital discharge.…”

Section: Hospital Readmissionsmentioning

confidence: 99%

“…The progressive increase in the number of sepsis and septic shock survivors emphasizes the long-term consequences of sepsis such as cognitive dysfunction and functional disabilities [21] , psychiatric morbidity [22] , decreased health-related quality of life [23] , unplanned hospital readmissions [10,24] , and late mortality [12,25] .…”

mentioning

confidence: 99%

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Update of Sepsis in the Intensive Care Unit

Genga¹,

Russell²

2017

J Innate Immun

116

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Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses. New sepsis definitions were produced and the Surviving Sepsis Campaign (SSC) 2016 was updated recently. Although hospital readmissions after sepsis are common, associated risk factors and how to manage patients who survive an episode of sepsis still need clarification. The immune dysfunction caused by sepsis/septic shock is complex, persistent, affects inflammatory and anti-inflammatory systems, and might be associated with long-term outcomes of sepsis. Several randomized controlled trials (RCT) that analyzed new (and old) interventions in sepsis/septic shock are discussed in this review in parallel with the SSC 2016 recommendations and other guidelines when relevant. RCTs addressing incidence, treatment, and prevention of important sepsis-associated organ dysfunction such as the acute respiratory distress syndrome, acute kidney injury, and brain dysfunction are highlighted. Finally, we briefly discuss the need for novel targets, predictive biomarkers, and new designs of RCTs in sepsis.

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Section: Hospital Readmissionsmentioning

confidence: 99%

Section: Hospital Readmissionsmentioning

confidence: 99%

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Update of Sepsis in the Intensive Care Unit

Genga¹,

Russell²

2017

J Innate Immun

116

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“…Hospital readmission is particularly common, with rates of 90-day readmission ranging from 30% to >40%(4–6). High readmission rates after sepsis have been seen in a variety of settings, suggesting that the problem is not unique to any particular healthcare system(3,5,7)…”

Section: Introductionmentioning

confidence: 99%

Readmissions for Recurrent Sepsis: New or Relapsed Infection?*

DeMerle

Royer

Mikkelsen

et al. 2017

Critical Care Medicine

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Objective Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. Design Retrospective cohort study. Setting University of Michigan Health System. Patients All hospitalizations (May 15, 2013 to May 14, 2015) with a principal ICD-9-CM diagnosis of septicemia (038.x), severe sepsis (995.92) or septic shock (785.52), as well as all subsequent hospitalizations and sepsis readmissions within 90 days. We determined organism and site of sepsis through manual chart abstraction. Interventions None Measurements and Main Results We identified 472 readmissions within 90 days of sepsis, of which 137 (29.1%) were for sepsis. In sepsis readmissions, the site and organisms were most commonly urinary (29.2%), gastrointestinal (20.4%), gram negative (29.9%), gram positive (16.8%) and culture negative (30.7%). 94 (68.6%) readmissions were for infection at the same site as initial sepsis hospitalization. 19% of readmissions were confirmed to be same site and same organism. However, accounting for the uncertainty from culture-negative sepsis, as many as 53.2% of readmissions could plausibly due to infections with both the same organism and same site. Conclusions Of the patients readmitted with sepsis within 90 days, two thirds had infection at the same site as their initial admission. Just 19% had infection confirmed to be from the same site and organism as the initial sepsis hospitalization. Half of readmissions were definitively for new infections, while an additional 34% were unclear since cultures were negative in one of the hospitalizations.

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“…Second, although the study used several well-validated tools to assess the many domains that are impaired in ICU survivors, in the absence of consensus on the best tools to use in post-ICU outcomes research, comparison across studies is inherently challenging (15). Additionally, the study was not designed to investigate whether the intervention had any effect on hospital readmissions, a challenge faced by nearly one out of four sepsis survivors (16). Finally, although the broad intervention in some ways is a strength of the study, it could have been too broad to significantly impact individual domains.…”

mentioning

confidence: 99%