Sepsis at a Safety Net Hospital: Risk Factors Associated With 30-Day Readmission

Weinreich, Mark; Styrvoky, Kim; Chang, Shelley; Girod, C; Ruggiero, Rosechelle

doi:10.1177/0885066617726753

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…Ten studies report a sepsis cohort starting from their index admission [27,35,37,41,44,46,50,51,53,55], twelve studies report a sepsis survivor cohort [9, 12, 30-32, 36, 45, 47, 52, 56, 58, 59], and four report a rehospitalisation cohort [28,34,40,42]. Ten were single-centre studies [28,37,40,44,47,50,51,55,56,59] with greater risk of bias compared to 21 studies [9, 12, 13, 27, 29-31, 33, 35, 36, 38, 39, 41, 42, 45, 48, 49, 53, 54, 57] that used large multi-centre databases with greater generalizability. Five studies that use notes review for outcome assessment [28,37,40,51,55] have a greater risk of ascertainment bias, compared to studies that use record linkage outcome assessment.…”

Section: Methodological Quality Of Included Studiesmentioning

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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Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

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

et al. 2020

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“…Readmission after a hospital stay is a significant contributor to healthcare costs and may be preventable. Early readmission, within the first few days after the initial discharge, has been reported to be unusually high for some conditions and places a substantial economic burden on the healthcare system (7)(8)(9). The rate of readmission for cirrhosis is high and is associated with a significant economic impact.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database

et al. 2021

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Background: Cirrhosis is associated with substantial inpatient morbidity and mortality. This study aimed to determine the trends in 30-day hospital readmission rates among patients with cirrhosis and identify factors associated with these readmissions.Methods: We conducted a retrospective analysis of data retrieved from the Nationwide Readmissions Database to determine trends in 30-day readmission for patients discharged with a diagnosis of cirrhosis in 2010 through 2014. Multivariate logistic regression analysis was used to identify predictors of readmission.Results: Among 303,346 patients identified from the database, the 30-day readmission rate for patients with a discharge diagnosis of cirrhosis was 31.4% (n=95,298). The trends in the readmission rates remained steady during the study period. On multivariate analysis, female sex, age 45 years or older, esophagogastroduodenoscopy (EGD) during admission, and disposition to a short-term care facility or skilled nursing facility protected against readmissions. In contrast, coverage by Medicaid insurance, admission during a weekend, nonalcoholic cause of cirrhosis, and history of hepatic encephalopathy and ascites were associated with readmission. Conclusions:We found an exceptionally high 30-day readmission rate in patients with cirrhosis, although it remained stable during the study period. This study identified some modifiable factors such as disposition to a short-term care facility or skilled nursing facility and patients' attendance of alcohol rehabilitation facilities that could decrease the likelihood of readmission and could inform local and national healthcare policymakers.

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“…The odds of readmission in individuals with CKD are unduly high, with a strong body of literature indicating that CKD is associated with up to twice the odds of all‐cause readmission compared to the general population (Ayatollahi et al, 2018; Weinreich et al, 2017). A retrospective cohort study revealed that patients with kidney failure have a 379% higher odds of being readmitted to the hospital within 30 days than pre‐kidney failure (Jasinski et al, 2017).…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with readmission in chronic kidney disease: Systematic review and meta‐analysis

Low

Lai

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2022

Journal of Renal Care

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BackgroundRisk factors associated with all‐cause hospital readmission are poorly characterised in patients with chronic kidney disease.ObjectiveA systematic review and meta‐analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease.Design, Participants & MeasurementsStudies involving adult patients were identified from four databases from inception to 31/03/2020. Random‐effects meta‐analyses were conducted to determine factors associated with all‐cause 30‐day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups.ResultsEighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta‐analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30‐day readmission. Other risk factors identified included increasing body mass index (kg/m2) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow‐up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist.ConclusionRisk‐reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.

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Sepsis at a Safety Net Hospital: Risk Factors Associated With 30-Day Readmission

Cited by 9 publications

References 27 publications

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

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

Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database

Factors associated with readmission in chronic kidney disease: Systematic review and meta‐analysis

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