Critical Care: Sepsis II |

Factors Associated With Discharge to Short-term Care, Long-term Care, and Death Among Patients With a Hospital Diagnosis of Sepsis FREE TO VIEW

Sarah Elfeky, MD; Pegah Golabi, MD; Munkhzul Otgonsuren, MS; Svetolik Djurkovic, MD; Mary Schmidt, MD; Zobair Younossi, MD
Author and Funding Information

Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA

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

Chest. 2016;150(4_S):362A. doi:10.1016/j.chest.2016.08.375
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SESSION TYPE: Original Investigation Poster

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

PURPOSE: Sepsis is a leading cause of death and constitutes a substantial health care burden. Understanding the factors that impact disposition of patients with sepsis is important from a societal and economic standpoint. Our aiam was to assess recent epidemiological characteristics, predictors of disposition and trends in patients with severe sepsis who died or were discharged to short term or long term care.

METHODS: Data from the National Inpatient Sample (NIS) and the National Hospital Discharge Survey (NHDS) between 2009 and 2012 were analyzed. Included were all adult hospital discharges with sepsis-related ICD-9 codes. Factors predicting transfer are derived from multivariate analysis of independent demographic, socio-economic, hospital and clinical characteristics.

RESULTS: Over 4 years 1,303,640 patients were admitted with sepsis. Fifteen percent of the patients died, 30% discharged to home, 34% transferred to long term facility and 4% were transferred to another acute care facility. In-hospital mortality decreased from 16.5% to 13.8% (P<0.001). Length of stay decreased from 6.7 to 5.9 days (P<0.001). These reduction in mortality and LOS were seen despite an increase in the number of comorbidities and chronic conditions during the study period (P<0.001). Furthermore, there were no significant changes in total charges (P=0.47). Multivariate analysis revealed, compared to the patients who were discharged routinely, the strongest predictors of in-hospital mortality were respiratory (OR: 6.02[95% CI, 5.87-6.18]), cardiovascular (OR: 3.25[95% CI, 3.17-3.33]) and hepatic (OR: 2.79[95% CI, 2.69-2.91]) failure as well as neurologic events (OR: 2.77[95% CI, 2.68-2.86]). The predictors of transfer to another acute short term care were rural location (OR: 4.50[95% CI, 4.02-5.03]) and small size of the hospital (OR: 2.96 [95% CI, 2.69-3.26]). The predictors of transfer to long term care were receiving major procedure in the operating room (OR: 2.14[95% CI, 2.09-2.19]), suffering a neurologic event (OR: 1.97[95% CI, 1.93-2.02]) and the diagnosis of respiratory failure (OR: 2.68 [95% CI, 2.61-2.76]). Compared to routine discharge, weight loss was an independent predictor of transfer to long term care, acute short term care, and in-hospital mortality.

CONCLUSIONS: Despite an increase in number of co-morbidities, the mortality associated with sepsis has decreased. The most important predictors of mortality were major organ failure. Additionally, hospital characteristics contributed to resource utilization.

CLINICAL IMPLICATIONS: The mortality and length of stay of sepsis is decreasing whereas total number of sepsis discharges is increasing.

DISCLOSURE: The following authors have nothing to disclose: Sarah Elfeky, Pegah Golabi, Munkhzul Otgonsuren, Svetolik Djurkovic, Mary Schmidt, Zobair Younossi

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