Critical Care: Sepsis I |

Outcomes of Severe Sepsis in Patients Admitted to Teaching Hospitals in Comparison to Non-Teaching Hospitals FREE TO VIEW

Swathi Sangli, MD; Boram Kim, DO; Shaun Noronha, MD; Pius Ochieng, MD; Raymonde Jean, MD
Author and Funding Information

Mt. Sinai West and Mt. Sinai St. Luke's Hospitals, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):352A. doi:10.1016/j.chest.2016.08.365
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Sepsis, with its high mortality and cost of treatment, is currently one of the biggest burdens on the United States (US) healthcare system. Examination of potential modifiable factors affecting sepsis outcomes may not only mitigate the financial strain sepsis causes, but also aid in improving the quality of its treatment. Studies have been done suggesting differences in quality of care between teaching and non-teaching hospitals. We looked at the association between hospital teaching status and sepsis outcomes by comparing mortality, length of stay, and cost between teaching and non-teaching hospitals.

METHODS: This is a retrospective study of the 2009-2011 Nationwide Inpatient Sample (NIS) dataset, which was used to assess various outcomes (mortality, length of stay, and total cost) of patients admitted with sepsis in teaching compared to non-teaching hospitals. SPSS was used to perform the analysis using the chi square and t-test.

RESULTS: A total of 226,649 cases of severe sepsis were identified, with the number of admissions relatively evenly distributed between teaching hospitals (115,484; 51%) and non-teaching (111,165; 49%) hospitals. The study population consisted of 50.9% males, 68.6% whites, and a mean age of 66.9 years (S.D 17.89). Mortality rates were significantly higher at 30.31% in teaching hospitals compared to 27.74% in non-teaching hospitals (p<0.001, hazards ratio 1.133, CI 1.113-1.154). Length of stay was 3.73 days longer (11.04 days versus 14.77 days) in teaching institutions compared to their non-teaching counterparts (p<0.001). Costs incurred per admission were also $37,894 higher at teaching hospitals ($150,747 versus $112,853) at the p<0.001 level.

CONCLUSIONS: This is the first study, to our knowledge, comparing sepsis in teaching and non-teaching hospitals in the US looking at national in-patient sample data. Our analysis shows that patients with severe sepsis treated in non-teaching hospitals had better outcomes and decreased cost. This difference could reflect distinctive hospital characteristics such as variable size, organization, facilities, and delivery of care. Mortality differences may be attributed to the higher proportions of sicker, at-risk sepsis populations served in the major teaching hospitals, requiring advanced supportive care. Admittedly our retrospective study has a few limitations. The severity of comorbidities was not studied, as APACHE scores were not available in our database. Also our analysis was based on the definition of “severe sepsis,” a term less frequently used since the updated sepsis criteria of 2016.

CLINICAL IMPLICATIONS: Teaching hospitals may be linked to poorer outcomes and increased cost in severe sepsis patients when compared to non-teaching hospitals. Further investigation is needed in order to model future research to determine if this pattern can be generalized to all teaching hospitals. If so, identification of modifiable structures and practices in teaching hospitals can lead to improved outcomes in patients with severe sepsis.

DISCLOSURE: The following authors have nothing to disclose: Swathi Sangli, Boram Kim, Shaun Noronha, Pius Ochieng, Raymonde Jean

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