title: Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis.
abstract: BACKGROUND
  Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain.
  
  
  OBJECTIVE
  To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors.
  
  
  METHODS
  We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period.
  
  
  RESULTS
  Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-year mortality (adjusted hazard ratio, 0.94; 95% confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who had more comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients).
  
  
  CONCLUSIONS
  Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.
authors.affiliation: 1 Department of Anesthesiology, Wan Fang Hospital, and.
authors.forename: Pei-wen
authors.initials: PW
authors.lastname: Chao
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ching-Min
authors.initials: CM
authors.lastname: Tseng
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Shih
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Chou
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D018908:Muscle Weakness / Q000209:etiology / Q000534:rehabilitation*; D010351:Patient Discharge; D057216:Propensity Score; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D017741:Survivors
keywords: epidemiology; mortality; rehabilitation; sepsis