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Beyond Surviving Sepsis: Thirty-Day Readmission Rates and Patient Characteristics at a Safety Net Hospital FREE TO VIEW

Kim Styrvoky, MD; Mark Weinreich, MD; Carlos Girod, MD; Rosechelle Ruggiero, MD
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UT Southwestern, Dallas, TX

Chest. 2015;148(4_MeetingAbstracts):336A. doi:10.1378/chest.2268558
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 26, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Sepsis is defined as having a systemic inflammatory response in the setting of infection. The number of cases of sepsis is rising annually. With increased awareness and attention, more patients are surviving their initial hospitalization. Little is known about patient’s short-term morbidity following discharge. The aim of this study is to describe patients with sepsis who are readmitted within 30 days at a safety net hospital.

METHODS: During fiscal year (FY) 2013, a retrospective chart review was performed of all patients with an index admission of sepsis who were readmitted to Parkland Hospital within 30 days. Primary outcome was the sepsis readmission rate. Secondary variables included comorbid conditions, length of stay, morbidity (ICU stays, need for hemodialysis, mechanical ventilation or vasopressor support), disposition, and readmission diagnosis.

RESULTS: There were 1445 admissions for sepsis in FY 2013 at Parkland Hospital; 230 discrete patients accounting for 306 admissions were readmitted within 30 days. The mean age was 50.4 ±14.4 years. Patients had increased morbidity prior to their initial sepsis admission; these patients accounted for 124 hospitalizations in the previous 30 days. Comorbid conditions included diabetes mellitus (35.0%), malignancy (25.8%), ESRD (20.9%), cirrhosis (11.4%), CHF (10.4%), and HIV (6.2%). A quarter of the readmissions occurred within 7 days, 47.0% were secondary to infection and 27.8% were readmitted with sepsis. The readmission length of stay (8.7 ± 12.9 days) was less than during the initial hospitalization (12.0 ± 12.5 days). Thirty-seven percent required ICU care during their initial hospitalization as compared to 25.1% during the readmission; mortality was 2.9%.

CONCLUSIONS: During FY 2013, 21.2% of patients admitted with sepsis were readmitted within 30 days at Parkland Hospital. Nearly half of the readmissions were secondary to infection. Morbidity was less than during the initial hospitalization as seen by decreased length of stay, need for ICU support, mechanical ventilation and vasopressors usage but still notable, as 25.1% required an ICU stay during the readmission.

CLINICAL IMPLICATIONS: Sepsis carries a high risk for 30 day readmission. Consideration should be made for post discharge care that is similar to other high risk disease states, such as CHF, in preventing readmissions. Further study is needed to delineate factors that may predict readmission.

DISCLOSURE: The following authors have nothing to disclose: Kim Styrvoky, Mark Weinreich, Carlos Girod, Rosechelle Ruggiero

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