Readmissions Among Patients With Severe Sepsis/Septic Shock Among Inner-City Minority New Yorkers

Crescencio, Juan Carlos Rico; Leu, Maria; Balaventakesh, Balaventakesh; Loganathan, Raghu

doi:10.1378/chest.1390287

Cited by 2 publications

(5 citation statements)

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“…Among sepsis patients, prior work demonstrates that inadequate consideration for presepsis level of function and utilization can result in an overestimation of the impact of sepsis on postdischarge health . Further, we found that the need for intensive care was not independently associated with an increased risk of high postsepsis utilization after adjusting for illness severity, a finding also seen in prior studies …”

Section: Discussionsupporting

confidence: 78%

“…Among sepsis survivors, most readmissions were not for sepsis or infectious diagnoses, which is a novel finding with implications for designing approaches to reduce rehospitalization. The pattern in sepsis is similar to that seen in other common and costly hospital conditions . For example, between 18% and 25% of Medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia were readmitted within 30 days; fewer than one‐third had the same diagnosis .…”

Section: Discussionmentioning

confidence: 58%

“…52,53 Further, we found that the need for intensive care was not independently associated with an increased risk of high postsepsis utilization after adjusting for illness severity, a finding also seen in prior studies. 17,23,38,51 Taken together, our findings might suggest that an optimal approach to posthospital care in sepsis should focus on treatment approaches that address diseasespecific problems within the much larger context of common hospital risks. However, further study is necessary to clearly define the mechanisms by which age, severity of illness, and intensive care affect subsequent healthcare utilization.…”

Section: Discussionmentioning

confidence: 80%

“…The pattern in sepsis is similar to that seen in other common and costly hospital conditions. 17,20,23,[38][39][40] For example, between 18% and 25% of Medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia were readmitted within 30 days; fewer than onethird had the same diagnosis. 20 The timing of readmission in our sepsis cohort was also similar to that seen in other conditions.…”

Section: Discussionmentioning

confidence: 99%

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Hospital readmission and healthcare utilization following sepsis in community settings

Liu

Lei

Prescott

et al. 2014

Journal of Hospital Medicine

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Background Sepsis, the most expensive cause of hospitalization in the US, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood. Objective To identify patient-level factors which contribute to post-sepsis mortality and healthcare utilization. Design, Setting, Patients A retrospective study of sepsis patients drawn from 21 community-based hospitals in Kaiser Permanente Northern California in 2010. Measurements We determined one-year survival and use of outpatient and facility-based healthcare before and after sepsis and used logistic regression to identify the factors that contributed to early readmission (within 30 days) and high utilization (≥15% of living days spent in facility-based care). Results Among 6,344 sepsis patients, 5,479 (86.4%) survived to hospital discharge. Mean age was 72 years with 28.9% of patients aged <65 years. Post-sepsis survival was strongly modified by age; one-year survival was 94.1% for <45 year olds and 54.4% for ≥85 year olds. A total of 978 (17.9%) patients were readmitted within 30 days; only a minority of all rehospitalizations were for infection. After sepsis, adjusted healthcare utilization increased nearly threefold compared with pre-sepsis levels and was strongly modified by age. Patient factors including acute severity of illness, hospital length of stay, and the need for intensive care were associated with early readmission and high healthcare utilization, however, the dominant factors explaining variability—comorbid disease burden and high pre-sepsis utilization—were present prior to sepsis admission. Conclusion Post-sepsis survival and healthcare utilization were most strongly influenced by patient factors already present prior to sepsis hospitalization.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Hospital readmission and healthcare utilization following sepsis in community settings

Liu

Lei

Prescott

et al. 2014

Journal of Hospital Medicine

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“…2 and the excluded papers are referenced in eMethods-1). We included one study from the reference scan of included full manuscripts, resulting in 56 unique studies that met our inclusion criteria for the systematic review (36 full manuscripts [9,12,13, and 20 conference abstracts [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79], (Fig. 2).…”

Section: Study Selectionmentioning

confidence: 99%

Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis

et al. 2020

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Purpose: Sepsis survivors have a higher risk of rehospitalisation and of long-term mortality. We assessed the rate, diagnosis, and independent predictors for rehospitalisation in adult sepsis survivors. Methods: We searched for non-randomized studies and randomized clinical trials in MEDLINE, Cochrane Library, Web of Science, and EMBASE (OVID interface, 1992-October 2019). The search strategy used controlled vocabulary terms and text words for sepsis and hospital readmission, limited to humans, and English language. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms. Results: The literature search identified 12,544 records. Among 56 studies (36 full and 20 conference abstracts) that met our inclusion criteria, all were non-randomised studies. Studies most often report 30-day rehospitalisation rate (mean 21.4%, 95% confidence interval [CI] 17.6-25.4%; N = 36 studies reporting 6,729,617 patients). The mean (95%CI) rehospitalisation rates increased from 9.3% (8.3-10.3%) by 7 days to 39.0% (22.0-59.4%) by 365 days. Infection was the most common rehospitalisation diagnosis. Risk factors that increased the rehospitalisation risk in sepsis survivors were generic characteristics such as older age, male, comorbidities, non-elective admissions, hospitalisation prior to index sepsis admission, and sepsis characteristics such as infection and illness severity, with hospital characteristics showing inconsistent associations. The overall certainty of evidence was moderate for rehospitalisation rates and low for risk factors. Conclusions: Rehospitalisation events are common in sepsis survivors, with one in five rehospitalisation events occurring within 30 days of hospital discharge following an index sepsis admission. The generic and sepsis-specific characteristics at index sepsis admission are commonly reported risk factors for rehospitalisation.

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Readmissions Among Patients With Severe Sepsis/Septic Shock Among Inner-City Minority New Yorkers

Cited by 2 publications

References 0 publications

Hospital readmission and healthcare utilization following sepsis in community settings

Hospital readmission and healthcare utilization following sepsis in community settings

Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis

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