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Frequency, cost, and risk factors of readmissions among severe sepsis survivors.
Crit Care Med. 2015 Apr; 43(4):738-46.CC

Abstract

OBJECTIVE

To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis.

DESIGN

Observational cohort study of Healthcare Cost and Utilization Project data.

SETTING

All nonfederal hospitals in three U.S. states.

PATIENTS

Severe sepsis survivors (n = 43,452) in the first two quarters of 2011.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We measured readmission rates and the associated cost and mortality of readmissions in severe sepsis survivors. We used multivariable logistic regression to identify patient and hospitalization characteristics associated with readmission. Of 43,452 sepsis survivors, 26% required readmission within 30 days and 48% within 180 days. The cumulative mortality rate of sepsis survivors attributed to readmissions was 8%, and the estimated cost was over $1.1 billion. Among survivors, 25% required multiple readmissions within 180 days and accounted for 77% of all readmissions. Age younger than 80 years (odds ratio, 1.14; 95% CI, 1.08-1.21), black race (odds ratio, 1.18; 95% CI, 1.10-1.26), and Medicare or Medicaid payor status (odds ratio, 1.21; 95% CI, 1.13-1.30; odds ratio, 1.34; 95% CI, 1.23-1.46, respectively) were associated with greater odds of 30-day readmission while female gender was associated with reduced odds (odds ratio, 0.92; 95% CI, 0.87-0.96). Comorbidities including malignancy (odds ratio, 1.34; 95% CI, 1.24-1.45), collagen vascular disease (odds ratio, 1.30; 95% CI, 1.15-1.46), chronic kidney disease (odds ratio, 1.24; 95% CI, 1.18-1.31), liver disease (odds ratio, 1.22; 95% CI, 1.11-1.34), congestive heart failure (odds ratio, 1.14; 95% CI, 1.08-1.19), lung disease (odds ratio, 1.12; 95% CI, 1.06-1.18), and diabetes (odds ratio, 1.12; 95% CI, 1.07-1.17) were associated with greater odds of 30-day readmission. Index hospitalization characteristics including longer length of stay, discharge to a care facility, higher hospital annual severe sepsis case volume, and higher hospital sepsis mortality rate were also positively associated with readmission rates.

CONCLUSION

The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates.

Links

PMC Free PDF

Authors+Show Affiliations

Goodwin AJ
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC. 2Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.
Rice DA
No affiliation info available
Simpson KN
No affiliation info available
Ford DW
No affiliation info available

MeSH

AgedCohort StudiesComorbidityCosts and Cost AnalysisData CollectionFemaleHospitalizationHumansMaleMedicaidMedicarePatient ReadmissionRegression AnalysisRetrospective StudiesRisk FactorsSepsisSex FactorsTime FactorsUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

25746745

Clinical Trial Links

Improving Morbidity During Post-Acute Care Transitions for Sepsis

Citation

Goodwin, Andrew J., et al. "Frequency, Cost, and Risk Factors of Readmissions Among Severe Sepsis Survivors." Critical Care Medicine, vol. 43, no. 4, 2015, pp. 738-46.
Goodwin AJ, Rice DA, Simpson KN, et al. Frequency, cost, and risk factors of readmissions among severe sepsis survivors. Crit Care Med. 2015;43(4):738-46.
Goodwin, A. J., Rice, D. A., Simpson, K. N., & Ford, D. W. (2015). Frequency, cost, and risk factors of readmissions among severe sepsis survivors. Critical Care Medicine, 43(4), 738-46. https://doi.org/10.1097/CCM.0000000000000859
Goodwin AJ, et al. Frequency, Cost, and Risk Factors of Readmissions Among Severe Sepsis Survivors. Crit Care Med. 2015;43(4):738-46. PubMed PMID: 25746745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frequency, cost, and risk factors of readmissions among severe sepsis survivors. AU - Goodwin,Andrew J, AU - Rice,David A, AU - Simpson,Kit N, AU - Ford,Dee W, PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2015/5/20/medline SP - 738 EP - 46 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 4 N2 - OBJECTIVE: To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis. DESIGN: Observational cohort study of Healthcare Cost and Utilization Project data. SETTING: All nonfederal hospitals in three U.S. states. PATIENTS: Severe sepsis survivors (n = 43,452) in the first two quarters of 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured readmission rates and the associated cost and mortality of readmissions in severe sepsis survivors. We used multivariable logistic regression to identify patient and hospitalization characteristics associated with readmission. Of 43,452 sepsis survivors, 26% required readmission within 30 days and 48% within 180 days. The cumulative mortality rate of sepsis survivors attributed to readmissions was 8%, and the estimated cost was over $1.1 billion. Among survivors, 25% required multiple readmissions within 180 days and accounted for 77% of all readmissions. Age younger than 80 years (odds ratio, 1.14; 95% CI, 1.08-1.21), black race (odds ratio, 1.18; 95% CI, 1.10-1.26), and Medicare or Medicaid payor status (odds ratio, 1.21; 95% CI, 1.13-1.30; odds ratio, 1.34; 95% CI, 1.23-1.46, respectively) were associated with greater odds of 30-day readmission while female gender was associated with reduced odds (odds ratio, 0.92; 95% CI, 0.87-0.96). Comorbidities including malignancy (odds ratio, 1.34; 95% CI, 1.24-1.45), collagen vascular disease (odds ratio, 1.30; 95% CI, 1.15-1.46), chronic kidney disease (odds ratio, 1.24; 95% CI, 1.18-1.31), liver disease (odds ratio, 1.22; 95% CI, 1.11-1.34), congestive heart failure (odds ratio, 1.14; 95% CI, 1.08-1.19), lung disease (odds ratio, 1.12; 95% CI, 1.06-1.18), and diabetes (odds ratio, 1.12; 95% CI, 1.07-1.17) were associated with greater odds of 30-day readmission. Index hospitalization characteristics including longer length of stay, discharge to a care facility, higher hospital annual severe sepsis case volume, and higher hospital sepsis mortality rate were also positively associated with readmission rates. CONCLUSION: The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25746745/Frequency_cost_and_risk_factors_of_readmissions_among_severe_sepsis_survivors_ DB - PRIME DP - Unbound Medicine ER -