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Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis

Meyer, Nathaniel, MD1; Harhay, Michael, O., PhD2; Small, Dylan, S., PhD3,4; Prescott, Hallie, C., MD, MSc5; Bowles, Kathryn, H., PhD, RN6,7; Gaieski, David, F., MD8; Mikkelsen, Mark, E., MD, MSCE2,4,9

doi: 10.1097/CCM.0000000000002872
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Objectives: A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia.

Design and Setting: Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015.

Patients: We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis.

Interventions: None.

Measurements and Main Results: From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014.

Conclusions: Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits.

1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

2Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

3The Wharton School, University of Pennsylvania, Philadelphia, PA.

4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

5Department of Internal Medicine, University of Michigan, VA Center for Clinical Management Research, Ann Arbor, MI.

6NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

7Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.

8Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.

9Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

Drs. Meyer and Harhay are cofirst authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the National Institutes of Health, National Institute of Nursing Research (NIH NINR R01 NR016014 01) (K.H.B., M.E.M.). Dr. Prescott is supported, in part, by National Institutes of Health/National Institute of General Medical Sciences K08 GM115859.

Drs. Prescott and Mikkelsen received support for article research from the National Institutes of Health (NIH). Dr. Prescott’s institution received funding from the NIH, and she disclosed government work. Dr. Bowles’s institution received funding from the National Institute of Nursing Research and the Agency for Healthcare Quality and Research, and she disclosed that she receives licensing royalties from the University of Pennsylvania not related to this topic. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: mark.mikkelsen@uphs.upenn.edu

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