Hospital readmission and healthcare utilization following sepsis in community settings

Abstract

Background: Sepsis, the most expensive cause of hospitalization in the United States, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood.

Objective: To identify patient-level factors that contribute to postsepsis mortality and healthcare utilization.

Design, setting, patients: A retrospective study of sepsis patients drawn from 21 community-based hospitals in Kaiser Permanente Northern California in 2010.

Measurements: We determined 1-year survival and use of outpatient and facility-based healthcare before and after sepsis and used logistic regression to identify the factors that contributed to early readmission (within 30 days) and high utilization (≥ 15% of living days spent in facility-based care).

Results: Among 6344 sepsis patients, 5479 (86.4%) survived to hospital discharge. Mean age was 72 years with 28.9% of patients aged <65 years. Postsepsis survival was strongly modified by age; 1-year survival was 94.1% for <45 year olds and 54.4% for ≥ 85 year olds. A total of 978 (17.9%) patients were readmitted within 30 days; only a minority of all rehospitalizations were for infection. After sepsis, adjusted healthcare utilization increased nearly 3-fold compared with presepsis levels and was strongly modified by age. Patient factors including acute severity of illness, hospital length of stay, and the need for intensive care were associated with early readmission and high healthcare utilization; however, the dominant factors explaining variability-comorbid disease burden and high presepsis utilization-were present prior to sepsis admission.

Conclusion: Postsepsis survival and healthcare utilization were most strongly influenced by patient factors already present prior to sepsis hospitalization.

Figure 1

Kaplan-Meier survival curves following living discharge after sepsis hospitalization, stratified by age categories.

Figure 2

Percentage of living days spent in facility-based care, including inpatient hospitalization, subacute nursing facility, and long-term acute care before and after index sepsis hospitalization.