Sepsis Hospital Readmissions Found to Be Common and Costly

Experts Recommend Timely Access to Hospice

The striking proportion of sepsis patients who undergo hospital readmissions continues to be common and costly, according to the authors of a study published in CHEST^® Journal.

The researchers recommend further research and action—including timely referral to hospice and palliative care in critically ill older patients and in patients with active malignancies—in order to prevent potentially unnecessary rehospitalizations.

“Our findings serve to create awareness among clinicians, administrators and policy makers alike regarding patient populations that are vulnerable to sepsis readmission.”

Current research has shown that patients rehospitalized after sepsis tend to have more costly readmissions and longer length of stay (LOS) than patients with acute myocardial infarction (AMI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia, several of the most common conditions among hospital readmissions.

Data from the Healthcare Cost and Utilization Project’s National Readmission Database (NRD) provided a cohort of 1,030,355 US patients 18 years of age or older who were hospitalized for sepsis during 2013 or 2014.

The annual US cost of sepsis readmissions estimated from this study is $3.5 billion.

Overall Findings

• The mean age of patients hospitalized for sepsis: 66.8 ± 17.4 years; 51.7% were women
• 12.8% of patients died during initial hospitalization
• Of surviving patients, 17.5% were readmitted within 30 days; 9.2% died during rehospitalization within 30 days
• The median time to readmission: 11 days (interquartile range, 5–19 days)
• The primary cause for readmission: infections (42.2%)
• Hospital readmission was associated with a higher cost of hospitalization ($24,291 vs $18,611, P < .001)

Predictors and Risk Factors of 30-Day Readmission

A multivariable regression model identified several strong predictors of 30-day readmission:

• Presence of a chronic health condition such as diabetes, chronic lung disease, chronic kidney disease and CHF (all P < .001)
• Discharge to a short- or longterm facility vs. home (P < .001)
• Higher burden of comorbidities (P < .001)
• Longer LOS during initial hospitalization

“Our findings serve to create awareness among clinicians, administrators and policy makers alike regarding patient populations that are vulnerable to sepsis readmission,” the authors conclude, with an aim to “develop strategies in terms of quality of care and care transitions.”

Source: “Epidemiology and Predictors of 30-Day Readmission in Patients with Sepsis,” CHEST® Journal; March 4, 2019; DOI: 10.1016/j.chest.2018.12.008. Gadre SK, Shah M, Duggal A; Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland; and Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.