title: Association Between Index Hospitalization and Hospital Readmission in Sepsis Survivors.
abstract: OBJECTIVE
  Hospital readmission is common after sepsis, yet the relationship between the index admission and readmission remains poorly understood. We sought to examine the relationship between infection during the index acute care hospitalization and readmission and to identify potentially modifiable factors during the index sepsis hospitalization associated with readmission.
  
  
  METHODS
  In a retrospective cohort study, we evaluated 444 sepsis survivors at risk of an unplanned hospital readmission in 2012. The primary outcome was 30-day unplanned hospital readmission.
  
  
  METHODS
  Three hospitals within an academic healthcare system.
  
  
  METHODS
  Four hundred forty-four sepsis survivors.
  
  
  RESULTS
  Of 444 sepsis survivors, 23.4% (95% CI, 19.6-27.6%) experienced an unplanned 30-day readmission compared with 10.1% (95% CI, 9.6-10.7%) among 11,364 nonsepsis survivors over the same time period. The most common cause for readmission after sepsis was infection (69.2%, 72 of 104). Among infection-related readmissions, 51.4% were categorized as recurrent/unresolved. Patients with sepsis present on their index admission who also developed a hospital-acquired infection ("second hit") were nearly twice as likely to have an unplanned 30-day readmission compared with those who presented with sepsis at admission and did not develop a hospital-acquired infection or those who presented without infection and then developed hospital-acquired sepsis (38.6% vs 22.2% vs 20.0%, p = 0.04). Infection-related hospital readmissions, specifically, were more likely in patients with a "second hit" and patients receiving a longer duration of antibiotics. The use of total parenteral nutrition (p = 0.03), longer duration of antibiotics (p = 0.047), prior hospitalizations, and lower discharge hemoglobin (p = 0.04) were independently associated with hospital readmission.
  
  
  CONCLUSIONS
  We confirmed that the majority of unplanned hospital readmissions after sepsis are due to an infection. We found that patients with sepsis at admission who developed a hospital-acquired infection, and those who received a longer duration of antibiotics, appear to be high-risk groups for unplanned, all-cause 30-day readmissions and infection-related 30-day readmissions.
authors.affiliation: 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, College Park, MD.3Department of Epidemiology and Public Health, University of Maryland, College Park, MD.4The Wharton School, University of Pennsylvania, Philadelphia, PA.5Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.6Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA.7Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.8Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.9Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sun
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.forename: Asaf
authors.initials: A
authors.lastname: Hanish
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010414:Pennsylvania; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000628:therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents