Patient characteristics and modifiable system-based factors were associated with costly hospital readmission after sepsis, according to a study published in CHEST.
Researchers used the Healthcare Cost and Utilization Project’s National Readmission Data to analyze predictors of 30-day hospital readmission after a patient initially presented with sepsis. The time between the 2 admissions and time to readmission were calculated for patients admitted with the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes for sepsis. Data on patient demographics and comorbidities were collected from the database.
Of the 1,030,355 admissions for sepsis included in the study, 51.7% were women, the mean age was 66.8±17.4 years old, and the initial in-hospital mortality rate was 12.8%. Among those who were discharged, 17.5% were readmitted within 30 days. Of those who were readmitted, 48% had significant baseline comorbidities, 82.1% had Medicare/Medicaid as their primary insurance, a greater proportion belonged to a lower socioeconomic strata, and they experienced a longer length of stay (P <.001) and had a higher cost of hospitalization (P <.001) than the patients who were not readmitted.
For the 179,253 patients readmitted, the median time to readmission was 11 days. During rehospitalization, 9.2% of this cohort died, 42.16% presented with infectious disease, 9.6% presented with gastrointestinal causes, and 8.73% presented with cardiovascular causes. Factors associated with 30-day readmission risk were diabetes (odds ratio [OR], 1.07; 95% CI, 1.06-1.08; P <.001), chronic lung disease (OR, 1.09; 95% CI, 1.07-1.10; P <.001), chronic kidney disease (OR, 1.12; 95% CI, 1.10-1.14; P <.001), congestive heart failure (OR, 1.16; 95% CI, 1.14-1.18; P <.001), discharge to short- or long-term nursing facility (OR, 1.13; 95% CI, 1.11-1.14; P <.001), higher Deyo modification of the Charlson comorbidity index (OR, 1.27; 95% CI, 1.24-1.29; P <.001), and longer length of stay during the initial sepsis admission (>3 days). After cost analysis, readmission accounted for 13% off all sepsis-related hospital costs, which came to a yearly total of more than $3.5 billion.
Limitations of this study included the potential for confounding variables due to the use of the database, the lack of data on patients transferred to outpatient settings, and the retrospective nature.
The researchers indicated “many modifiable system-based factors are associated with readmissions after an episode of sepsis, but, more importantly, we also identified a number of patient-based characteristics associated with readmission after an episode of sepsis.”
Gadre SK, Shah M, Mireles-Cabodevila E, Patel B, Duggal A. Epidemiology and predictors of 30-day readmission in patients with sepsis. CHEST. 2019;155(3):483-490.