PURPOSE: To assess whether recent prior health care utilization is associated with total mortality among patients hospitalized with sepsis and severe sepsis.
METHODS: We retrospectively identified a cohort of 23,587 patients aged 50 or older hospitalized with sepsis or severe sepsis. Sepsis was identified by primary discharge diagnosis ICD-9 codes 0.38.x, 995.91, 995.92, 785.52, 785.5 and 518.5 coded in conjunction with a secondary severity code. Random chart review showed 87% PPV. Each patient was followed for up to 12 months or until death. All out-patient clinic visits, emergency department (ED) visits and any hospitalization in the preceding 12 months were retrieved from our administrative records.
RESULTS: The mean age of the cohort was 72 ± 10 years and 52% were male. Compared to patients with no hospitalizations in the prior 12 months, the HR of death for those with 1–5 and >5 hospitalizations were 1.57 (95% CI 1.51–1.64) and 1.77 (95% CI 1.61–1.94), respectively. When analyzed by ED visits with patients having no ED visits as referent, the HR of death for those with 1–5 and >5 ED visits were 1.15 (95% CI 1.09–1.21) and 1.34 (95% CI 1.25–1.44), respectively. When analyzed by clinic visits with patients without clinic visits as referent, the HR of death for those with 1–10 and >10 clinic visits were 0.79 (95% CI 0.72–0.88) and 0.75 (95% CI 0.67–0.82), respectively.
CONCLUSION: In patients hospitalized with sepsis, those patients with recent prior hospitalizations and ED visits of any cause had greater mortality rates than those who did not. Conversely, patients with at least one out-patient clinic visit had lower mortality than those who had not been seen in the clinic in the prior 12 months.
CLINICAL IMPLICATIONS: Patients who have received routine out-patient care may fare better when hospitalized with sepsis than those who do not, while patients who have received ED or in-patient care fare worse when hospitalized with sepsis than those who have not.
DISCLOSURE: Ahmed Ijaz Shah, No Financial Disclosure Information; No Product/Research Disclosure Information