Sepsis Hospital Readmissions Significantly Higher Than Non-Sepsis, with Adverse Outcomes Reported

Sepsis patients are at a significantly higher risk of hospital readmission and post-acute care use than non-sepsis patients, according to the results of a two-year observational cohort study published in the Annals of the American Thoracic Society. Investigators also found that hospital readmissions after sepsis are more likely to result in death or discharge to hospice.

“Given the frequency of hospice use among survivors...the question (of) whether timely access to palliative care could be optimized for targeted subgroups...is an additional direction worth pursuing.”
-Mark E. Mikkelsen, MD, MSCE, Perelman School of Medicine, University of Pennsylvania

"Sepsis is a growing public health problem," the study authors state, noting that "improving care transitions and reducing 30-day hospital readmissions have become a national priority in the United States." However, research into these topics has been sparse, they write.

University of Pennsylvania (UP) researchers set out to compare post-acute care use, rehospitalization rates and readmission outcomes of sepsis patients vs. those without sepsis between 2010 and 2012, and to identify risk factors for post-sepsis rehospitalization. The study cohort included 112,578 adult hospital admissions (73,999 unique patients) to UP Health System who were discharged and not transitioned to hospice, and therefore at risk for readmission.

Overall Findings

• Sepsis was present in 4.4% of the initial eligible hospitalizations.
• 2.2% of the initial sepsis hospitalizations resulted in death and 1.9% resulted in transition to hospice.
• Patients with sepsis were more likely to be older (P = 0.005), male (P < 0.001), single (P= 0.02), Medicare beneficiaries (P < 0.001), to have a greater number of comorbid conditions (P < 0.001), and to have a malignancy diagnosis (P < 0.001).

Key Findings

• 30-day readmission rate was 27.3% for sepsis and 15.6% for non-sepsis (P < 0.001).
• Post-acute care usage, driven by skilled care facility placement, was higher post-sepsis than non-sepsis (35.4% vs 15.8%).
• Death or transition to hospice was more likely in post-sepsis readmissions (13.3% vs 6.1% non-sepsis; P < 0.001).
• Several independent risk factors were found to be associated with 30-day rehospitalization after sepsis, including: malignancy diagnosis (P < 0.001); greater number of hospitalizations within the prior year (P < 0.001); nonelective index hospitalization (P = 0.02), and having one or more procedures during hospitalization (P < 0.001).

The study authors stress that readmission, post-acute care and mortality are common after sepsis, and that awareness is vital. They point out that the readmission rates after sepsis are comparable to those of conditions identified as high risk by the Centers for Medicare & Medicaid Services, noting these findings “support the recommendation that sepsis is an additional condition that warrants attention at the national level.”

In conclusion, the authors suggest that “timely access to palliative care services could be optimized for targeted subgroups, given the frequency of hospice use” in this patient population.

Source: "Post-Acute Care Use and Hospital Readmission after Sepsis," Annals of the American Thoracic Society; June 2015; DOI: 10.1513/AnnalsATS.201411-504OC. Jones TK, Fuchs BD, Small DS, Halpern SD, Hanish A, Umscheid CA, Baillie CA, et al; Department of Medicine; Division of Pulmonary, Allergy, and Critical Care; and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.