Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type

Abstract

Objective:To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative.Methods:A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and above, with sepsis-associated stays between February 2012 and January 2013 at an academic medical center and 5 community hospitals in Texas.Results:Sepsis was present on admission in almost 85% of cases and acquired in-hospital in the remainder. The overall inpatient death rate was 17.2%, but was higher in hospital-acquired sepsis (38.6%, medical; 29.2%, surgical) and Stages 2 (17.6%) and 3 (36.4%) compared with Stage 1 (5.9%). Patients treated at the academic medical center had a higher death rate (22.5% vs. 15.1%, P<0.001) and were more costly ($68,050±184,541 vs. $19,498±31,506, P<0.001) versus community hospitals.Conclusions:Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs.

Determinants of Home Discharge Among Survivors of Necrotizing Fasciitis: A Population-Level Analysis

“…The finding of favorable odds of home discharge among survivors of NF managed in a teaching hospital contrast prior reports of higher risk of hospital mortality in patients with NF [ 3 ] and sepsis [ 18 , 23 ] managed in teaching facilities. The increased risk of death is thought to reflect more severely ill population in teaching hospitals [ 18 ]. Thus, higher residual morbidity with lower functional state would be expected among survivors of severe illness in teaching facilities, with corresponding lower rates of home discharge.…”

“…The adverse impact of rising age on the odds of home discharge among survivors of NF-associated hospitalization is consistent with prior reports noting similar patterns among patients with sepsis [ 18 ] and trauma [ 19 ], and with age-related increasing risk of death among patients with NF [ 3 , 5 , 7 ].…”

Risk of SOFA Deterioration in Conservative Treatment for Emphysematous Pyelonephritis: Pitfalls of Current Trends in Therapeutics from Multicenter Clinical Experience

“…One patient without drainage nosocomially developed fatal urosepsis in the present study. Great differences in mortality were reported to exist between patients with sepsis present on admission to the hospital and patients who develop sepsis in the hospital (12 and 35%, respectively) [26]. Less-invasive management can cause deterioration in SOFA after admission, yielding a risk of septic mortality.…”

Factores de riesgo de mortalidad en la sepsis nosocomia

“…32,33,34 Surgical patients accounted for a high proportion in our study (68.9%), similar to the work of Jones et al, where more than a half of the patients with hospital acquired sepsis were surgical in origin. 8 The significant presence of surgical patients in our cohort is probably related to the fact that our hospital has a large surgical activity, being a reference center in our region for many surgeries. Surgical procedures imply invasive procedures and intensive monitoring of hospital acquired infections.…”

“…The average cost of each case of Hospital acquired sepsis (38,369 $) clearly exceed that caused by Healthcare associated sepsis (8,796 $) or that caused by community acquired severe sepsis (7,023 $), 7 exhibiting also a greater mortality. 7,8 However, nosocomial sepsis remains between the major preventable causes of admission to the Intensive Care Unit (ICU). 9 Interestingly, this disease has been poorly studied outside of ICU settings.…”