Frequency, cost, and risk factors of readmissions among severe sepsis survivors.
OBJECTIVE
To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis.


METHODS
Observational cohort study of Healthcare Cost and Utilization Project data.


METHODS
All nonfederal hospitals in three U.S. states.


METHODS
Severe sepsis survivors (n = 43,452) in the first two quarters of 2011.


METHODS
None.


RESULTS
We measured readmission rates and the associated cost and mortality of readmissions in severe sepsis survivors. We used multivariable logistic regression to identify patient and hospitalization characteristics associated with readmission. Of 43,452 sepsis survivors, 26% required readmission within 30 days and 48% within 180 days. The cumulative mortality rate of sepsis survivors attributed to readmissions was 8%, and the estimated cost was over $1.1 billion. Among survivors, 25% required multiple readmissions within 180 days and accounted for 77% of all readmissions. Age younger than 80 years (odds ratio, 1.14; 95% CI, 1.08-1.21), black race (odds ratio, 1.18; 95% CI, 1.10-1.26), and Medicare or Medicaid payor status (odds ratio, 1.21; 95% CI, 1.13-1.30; odds ratio, 1.34; 95% CI, 1.23-1.46, respectively) were associated with greater odds of 30-day readmission while female gender was associated with reduced odds (odds ratio, 0.92; 95% CI, 0.87-0.96). Comorbidities including malignancy (odds ratio, 1.34; 95% CI, 1.24-1.45), collagen vascular disease (odds ratio, 1.30; 95% CI, 1.15-1.46), chronic kidney disease (odds ratio, 1.24; 95% CI, 1.18-1.31), liver disease (odds ratio, 1.22; 95% CI, 1.11-1.34), congestive heart failure (odds ratio, 1.14; 95% CI, 1.08-1.19), lung disease (odds ratio, 1.12; 95% CI, 1.06-1.18), and diabetes (odds ratio, 1.12; 95% CI, 1.07-1.17) were associated with greater odds of 30-day readmission. Index hospitalization characteristics including longer length of stay, discharge to a care facility, higher hospital annual severe sepsis case volume, and higher hospital sepsis mortality rate were also positively associated with readmission rates.


CONCLUSIONS
The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates.
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC. 2Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.
Andrew J
AJ
Goodwin
David A
DA
Rice
Kit N
KN
Simpson
Dee W
DW
Ford
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003625:Data Collection / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012737:Sex Factors; D013997:Time Factors; D014481:United States