title: Obesity and Mortality, Length of Stay and Hospital Cost among Patients with Sepsis: A Nationwide Inpatient Retrospective Cohort Study.
abstract: The objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older.
  
  
  
  It was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-payer inpatient care database in the United States. Hospitalizations of sepsis patients 20 years of age or older were included. All 25 primary and secondary diagnosis fields were screened to identify patients with sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Obesity was the exposure of interest. It was one of the 29 standardized Elixhauser comorbidity measures and readily available in the dataset as a dichotomized variable. The outcome measures were all-cause in-hospital death, length of stay and hospital cost.
  
  
  
  After weighting, our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the US in 2011. The overall all-cause mortality rate was 14.8%, the median hospital length of stay was 7 days and the median hospital cost was $15,917. After adjustment, the all-cause mortality was lower (adjusted OR = 0.84; 95% CI = 0.81 to 0.88); the average hospital length of stay was longer (adjusted difference = 0.65 day; 95% CI = 0.44 to 0.86) and the hospital cost per stay was higher (adjusted difference = $2,927; 95% CI = $1,606 to $4,247) for obese sepsis patients as compared to non-obese ones.
  
  
  
  With this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; however it was also associated with greater duration and cost of hospitalization.
authors.affiliation: Department of General Planning, Vinmec International Hospital, Hanoi, Vietnam.
authors.forename: Anh Tuan
authors.identifier: 0000-0003-2608-0152
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Tsai
authors.affiliation: Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas, United States of America.
authors.forename: Lu-Yu
authors.initials: LY
authors.lastname: Hwang
authors.affiliation: Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Texas, United States of America.
authors.forename: Dejian
authors.initials: D
authors.lastname: Lai
authors.affiliation: Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Markham
authors.affiliation: Division of Critical Care Medicine, Medical School, University of Texas Health Science Center at Houston, Texas, United States of America.
authors.forename: Bela
authors.initials: B
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000191:economics* / Q000401:mortality*; D014481:United States