Frequent identical admission–readmission episodes are associated with increased mortality

Fry, Christopher; Fluck, David; Han, Thang S.

doi:10.7861/clinmed.2020-0930

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…A few studies report a high proportion (38.0 to 61.2%) of hospital readmission specifically due to infection (including sepsis) [13,35], but there is a lack of data in the literature regarding 1-year readmission specifically due to sepsis. In line with previous studies, the mortality rate was twice higher for patients who experienced hospital readmission for recurrent sepsis compared to the patients without hospital readmission or re-hospitalized for other causes (39.8% vs 19.6%) [6,36].…”

Section: Hospital Readmission and Associated Mortalitysupporting

confidence: 90%

“…Recurrent sepsis emerged as an important risk factor for 1-year mortality (~ threefold increase in 1-year mortality), along with five others important risk factors: age, cancer, dementia, septic shock and skin and soft tissues infection (> 1.5-fold increase in 1-year mortality). Indeed, readmission for sepsis was associated with higher risk of 30-days, 6-month and 2-years mortality in previous studies [6,36]. Apart from recurrent sepsis, age, dementia and cancer, which usually result in complicated clinical scenario, represented important risk factors [23,[48][49][50].…”

Section: Recurrent Sepsis and Other Risk Factors For 1-year Mortalitymentioning

confidence: 86%

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One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality—a French nationwide study

et al. 2022

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Background Sepsis is a complex health condition, leading to long-term morbidity and mortality. Understanding the risk factors for recurrent sepsis, as well as its impact on mid- and long-term mortality among other risk factors, is essential to improve patient survival. Methods A risk factor analysis, based on French nationwide medico-administrative data, was conducted on a cohort of patients above 15 years old, hospitalized with an incident sepsis in metropolitan France between 1st January 2018 and 31st December 2018 and who survived their index hospitalization. Two main analyses, focusing on outcomes occurring 1-year post-discharge, were conducted: a first one to assess risk factors for recurrent sepsis and a second to assess risk factors for mortality. Results Of the 178017 patients surviving an incident sepsis episode in 2018 and included in this study, 22.3% died during the 1-year period from discharge and 73.8% had at least one hospital readmission in acute care, among which 18.1% were associated with recurrent sepsis. Patients aged between 56 and 75, patients with cancer and renal disease, with a long index hospital stay or with mediastinal or cardiac infection had the highest odds of recurrent sepsis. One-year mortality was higher for patients with hospital readmission for recurrent sepsis (aOR 2.93; 99% CI 2.78–3.09). Among all comorbidities, patients with cancer (aOR 4.35; 99% CI 4.19–4.52) and dementia (aOR 2.02; 99% CI 1.90–2.15) had the highest odds of 1-year mortality. Conclusion Hospital readmission for recurrent sepsis is one of the most important risk factors for 1-year mortality of septic patients, along with age and comorbidities. Our study suggests that recurrent sepsis, as well as modifiable or non-modifiable other risk factors identified, should be considered in order to improve patient care pathway and survival.

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Section: Hospital Readmission and Associated Mortalitysupporting

confidence: 90%

Section: Recurrent Sepsis and Other Risk Factors For 1-year Mortalitymentioning

confidence: 86%

One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality—a French nationwide study

et al. 2022

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“…Partly similar to our study, Pandolfi et al [ 9 ] found that hospital readmission due to recurrent sepsis was associated with an increased risk of 1-year mortality. Likewise, some previous studies showed that readmission for recurrent sepsis was indeed a risk factor related to a higher mortality rate [ 18 , 19 ]. Whereas, these studies on repeated sepsis rarely involved AD population.…”

Section: Discussionmentioning

confidence: 85%

Prognostic impacts of repeated sepsis in intensive care unit on autoimmune disease patients: a retrospective cohort study

Yang,

Chen,

Zhang

et al. 2024

BMC Infect Dis

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Background Autoimmune diseases (ADs) may be complicated by sepsis when intensive care unit (ICU) admission. But repeated sepsis among AD patients has not been studied yet. The aim of this study is to investigate the impact of repeated in-ICU sepsis on the 1-year overall-cause mortality, septic shock and in-ICU death of AD patients. Methods Data of AD patients with sepsis retrieved from Medical Information Mart for Intensive Care IV (MIMIC-IV) database were divided into the single group and the repeated group according to the frequency of in-ICU sepsis. Propensity score matching was used to balance inter-group bias. Cox proportional hazard regression and sensitivity analysis were utilized to assess the variables on mortality. Results The incidence of repeated in-ICU sepsis in baseline was 19.8%. The repeated in-ICU sepsis was a risk factor for 1-year overall-cause mortality among AD patients (adjusted hazard ratio [HR] = 1.50, 95% CI: 1.16–1.93, P = 0.002), with robust adjusted HRs by the adjustment for confounders in the sensitivity analysis (all P < 0.01). Maximum Sequential Organ Failure Assessment (Max SOFA), Charlson comorbidity index (CCI) and Simplified Acute Physiology Score-II (SAPS-II) were risk factors for 1-year overall-cause mortality among AD with repeated sepsis (Max SOFA: HR = 1.09, P = 0.002; CCI: HR = 1.08, P = 0.039; SAPS-II: HR = 1.03, P < 0.001). Conclusions Compared to single hit, repeated in-ICU sepsis was independently related to a higher risk of 1-year overall-cause mortality among AD patients. Assessment tools (Higher SOFA, CCI and SAPS-II scores) were closely linked to poor prognosis of AD with repeated sepsis and helped to reflect ill physical conditions for the patients.

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“…We were surprised to find that 30‐day readmission increased after implementation of the AN role, especially in light of improved patient satisfaction. A higher readmission rate, associated with higher costs and mortality, can negatively impact both patients and hospitals (Carey & Stefos, 2016; Fry et al, 2021). It is possible that efforts to discharge patients earlier may have caused some patients to be discharged before clinical recovery or fully optimized transition planning.…”

Section: Discussionmentioning

confidence: 99%

Effect of an attending nurse on timeliness of discharge, patient satisfaction, and readmission

Cyrus

Kulkarni

Astik

et al. 2022

J Nursing Management

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Aims To improve the timeliness and quality of discharge for patients by creating the role of the attending nurse. Background Discharge time affects hospital throughput and patient satisfaction. Bedside nurses and hospitalists have competing priorities that can hinder performing timely, high‐quality discharges. Methods This retrospective analysis evaluated the effect of an attending nurse paired with a hospital medicine physician on discharge time and quality. A total of 8329 patient discharges were eligible for the study, and propensity score matching yielded 2715 matched pairs. Results In the post‐intervention matched cohort, the percentage of patients discharged before 2 PM increased from 34.4% to 45.9% (p < .01), and the median discharge time moved 48 min earlier. In the unmatched cohort, patient satisfaction with the discharge process improved on several questions. While length of stay was not affected, the 30‐day readmission rate did increase from 8.9% to 10.7% (p = .02). Conclusion With the new attending nurse role, we positively impacted throughput by shifting discharge times earlier in the day while improving patient satisfaction. Length of stay stayed the same but the 30‐day readmission rate increased. Implications for Nursing Management Our multidisciplinary approach to the problem of late discharge times led to the creation of a new role. This role made ownership of discharge tasks clear and reduced competing priorities, freeing up nurses and hospitalists to perform other care‐related responsibilities without holding up discharges.

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Frequent identical admission–readmission episodes are associated with increased mortality

Cited by 7 publications

References 26 publications

One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality—a French nationwide study

One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality—a French nationwide study

Prognostic impacts of repeated sepsis in intensive care unit on autoimmune disease patients: a retrospective cohort study

Effect of an attending nurse on timeliness of discharge, patient satisfaction, and readmission

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