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Critical Care |

Patterns of Hospital Readmission Following an Index Hospitalization for Sepsis

David Rice, MD; Kit Simpson, DrPH; Andrew Goodwin, MD; Dee Ford, MD
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Medical University of South Carolina, Charleston, SC


Chest. 2013;144(4_MeetingAbstracts):400A. doi:10.1378/chest.1699902
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Abstract

SESSION TITLE: Quality Improvement in the ICU I

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM

PURPOSE: Sepsis is a leading cause of morbidity and mortality with a high cost and increasing incidence. While hospital readmission patterns are described in certain chronic conditions such as congestive heart failure, COPD, and malignancy, there is scarce insight on this topic as it applies to sepsis. Thus, the aim of our study was to characterize hospital readmissions following an index admission for sepsis.

METHODS: We conducted an observational, retrospective analysis of all patients discharged from hospitals in the state of Florida in 2010 using the Healthcare Cost and Utilization Project (HCUP) inpatient state database. A cohort of patients was identified who had sepsis, severe sepsis, or septic shock present on admission (ICD-9 codes 995.91, 995.92 and 785.52). The first admission for sepsis in these patients was deemed the index admission and subsequent admissions were classified as being for sepsis or non-sepsis. Time intervals used in calculating readmissions were within 30, 90, and 180 days.

RESULTS: During the index admission, in-hospital mortality was 18.2% and among the 56,527 surviving patients, average hospital length of stay was 13.2 days and hospital charge per case was $116,253. Of the survivors, 47.7% (26,961) required readmission during the study period which accounted for 36,462 hospitalizations. Of these readmissions, 26% (9,505) were for sepsis and 74% (26,957) were for non-sepsis. These hospitalizations represented a patient’s second or greater readmission in 42% of cases. For recurrent sepsis and non-sepsis, the 30-day readmission percentage was 6.6% and 19.9%, respectively; and the 90-day readmission percentage was 10.6% and 31.6%, respectively.

CONCLUSIONS: We found that hospital readmissions in patients with sepsis are common for recurrent sepsis and non-sepsis diagnoses. Future studies should investigate the impact of readmissions following a hospitalization for sepsis as a contributor to sepsis costs and identify potential strategies to reduce readmissions.

CLINICAL IMPLICATIONS: Ours is the first study to report on readmissions for recurrent sepsis and we found higher readmissions for non-sepsis than that previously published.

DISCLOSURE: The following authors have nothing to disclose: David Rice, Kit Simpson, Andrew Goodwin, Dee Ford

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