Epidemiology and Costs of Postsepsis Morbidity, Nursing Care Dependency, and Mortality in Germany, 2013 to 2017

Fleischmann-Struzek, Carolin; Rose, Norman; Freytag, Antje; Spoden, Melissa; Prescott, Hallie C.; Schettler, Anna; Wedekind, Lisa; Ditscheid, Bianka; Storch, Josephine; Born, Sebastian; Günster, Christian; Reinhart, Konrad; Hartog, Christiane S.

doi:10.1001/jamanetworkopen.2021.34290

Cited by 47 publications

(50 citation statements)

References 36 publications

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“…The substantial increase in need for nursing between 3 months before and 6 months after sepsis (see Table 3) indicates the burden of disease of both sepsis survivors and their relatives as well the socioeconomic impact on society. Our findings go along with the recent German claims data analysis by Fleischmann-Struzek et al, finding 31.5% (95%CI, 31.1-31.8%) new nursing care dependency during the first year post sepsis [44,54]. Within the U.S. Nationwide Inpatient Sample (NIS), Kumar et al demonstrated an increasing need of nursing care after sepsis due to higher survival rates with one third of survivors of severe sepsis being discharged to skilled nursing facilities [55].…”

Section: Nursingsupporting

confidence: 90%

“…Baseline characteristics such as age [41], percentage of ICU-treatment [41], mean Charlson Comorbidity Index [44] and APACHE II-Score [42] suggest lower disease severity of these cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective Canadian cohort study using administrative data found even higher total mean costs (CAN$ 66,781) in 64,204 severe sepsis survivors [40] with a mean age of 74 years and a mean ADG Score of 34. In contrast, other studies resulted in lower mean total costs for the same period, as another U.S. claims data analyses of n = 2834 patients with severe sepsis (totaling $18,425) [41] -two prospectively followed cohorts of n = 502 Canadian severe sepsis survivors (totaling CAN$ 20,855) [42] and n = 839 U.S. ARDS (acute respiratory distress syndrome) survivors (totaling $23,651, including $6761 outpatient costs) [43] and a recent extensive German claims data analysis among 116,507 sepsis survivors (totaling €14,891 [44].…”

Section: Discussionmentioning

confidence: 99%

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Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

Schmidt

Huelle

Reinhold

et al. 2022

JCM

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Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p < 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.

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Section: Nursingsupporting

confidence: 90%

“…Baseline characteristics such as age [41], percentage of ICU-treatment [41], mean Charlson Comorbidity Index [44] and APACHE II-Score [42] suggest lower disease severity of these cohorts.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

Schmidt

Huelle

Reinhold

et al. 2022

JCM

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“…Es zeigte sich, dass 3 von 4 Sepsisüberlebenden im ersten Jahr nach Sepsis unter neu aufgetretenen psychischen, physischen oder kognitiven Erkrankungen litten, die häufig überlappten 14 .…”

Section: Hintergrundunclassified

White Paper – Verbesserung der Versorgungs- und Behandlungsangebote für Menschen mit Sepsis- und Infektionsfolgen

Fleischmann-Struzek

Rose

Born

et al. 2022

Dtsch Med Wochenschr

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ZusammenfassungHunderttausende Menschen mit Sepsis- und Infektionsfolgen werden derzeit in Deutschland nicht optimal versorgt. Dieses White Paper stellt Maßnahmen zur Verbesserung der Versorgung vor, die von einer multidisziplinären Expertengruppe im Rahmen des Innovationsfonds-Projektes SEPFROK erarbeitet wurden. Eine optimale Versorgung beruht auf 4 Säulen: 1. der sektorenübergreifenden Erfassung der Folgen und einem strukturierten Entlass- und Überleitungsmanagement, 2. einem gezielten Angebot von interdisziplinärer Rehabilitation- und Nachsorge mit struktureller Unterstützung, 3. der Stärkung der spezifischen Gesundheitskompetenz von Betroffenen und Angehörigen und 4. der Intensivierung der Forschung zu Ursachen, Prävention und Therapie der Folgen. Hierfür müssen entsprechende sektorenübergreifende Versorgungsstrukturen und sozialrechtliche Rahmenbedingungen geschaffen werden.

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“…Among the myriad of new diseases which can be associated with sepsis survival ( 6 ), new chronic care dependency, need for chronic dialysis and inability to breathe without mechanical support can be regarded as particularly crippling conditions. We explored the development of these adverse outcomes, the risk of mortality and the impact of corresponding risk factors using a large database of sepsis survivors identified in nationwide German health claims records of the AOK (Allgemeine Ortskrankenkasse) health insurance, which covers 30% of the German population ( 16 ). The study was registered (DRKS00016340) and approved by the local institutional review board of the Jena University Hospital, Germany (2019-1282-Daten).…”

Section: Introductionmentioning

confidence: 99%

Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

et al. 2022

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Sepsis survival is associated with adverse outcomes. Knowledge about risk factors for adverse outcomes is lacking. We performed a population-based cohort study of 116,507 survivors of hospital-treated sepsis identified in health claims data of a German health insurance provider. We determined the development and risk factors for long-term adverse events: new dependency on chronic care, chronic dialysis, long-term respiratory support, and 12-month mortality. At-risk patients were defined by absence of these conditions prior to sepsis. Risk factors were identified using simple and multivariable logistic regression analyses. In the first year post-sepsis, 48.9% (56,957) of survivors had one or more adverse outcome, including new dependency on chronic care (31.9%), dialysis (2.8%) or respiratory support (1.6%), and death (30.7%). While pre-existing comorbidities adversely affected all studied outcomes (>4 comorbidities: OR 3.2 for chronic care, OR 4.9 for dialysis, OR 2.7 for respiratory support, OR 4.7 for 12-month mortality), increased age increased the odds for chronic care dependency and 12-month mortality, but not for dialysis or respiratory support. Hospital-acquired and multi-resistant infections were associated with increased risk of chronic care dependency, dialysis, and 12-month mortality. Multi-resistant infections also increased the odds of respiratory support. Urinary or respiratory infections or organ dysfunction increased the odds of new dialysis or respiratory support, respectively. Central nervous system infection and organ dysfunction had the highest OR for chronic care dependency among all infections and organ dysfunctions. Our results imply that patient- and infection-related factors have a differential impact on adverse life changing outcomes after sepsis. There is an urgent need for targeted interventions to reduce the risk.

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Epidemiology and Costs of Postsepsis Morbidity, Nursing Care Dependency, and Mortality in Germany, 2013 to 2017

Cited by 47 publications

References 36 publications

Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

White Paper – Verbesserung der Versorgungs- und Behandlungsangebote für Menschen mit Sepsis- und Infektionsfolgen

Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

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