Increased healthcare facility use in veterans surviving sepsis hospitalization

Abstract

Purpose: We sought to measure inpatient healthcare utilization among U.S. Veteran Affairs beneficiaries surviving sepsis hospitalization, and to examine how post-sepsis utilization varies by select patient characteristics.

Materials and methods: Retrospective cohort study of 26,561 Veterans who survived sepsis hospitalization in 2009. Using difference-in-differences analysis, we compared changes in healthcare utilization in one year before and one year after sepsis hospitalization by Veteran age, illness severity, and recent nursing facility use.

Results: Median days in a healthcare facility increased from 5 to 10. Veterans with recent nursing facility use spent a median 65days (or 86% of days alive) in a healthcare facility in the year after sepsis. Older age, greater illness severity, and recent nursing home use were each associated with spending more days, and a greater proportion of days alive, in a healthcare facility during the year after sepsis. However, none of these characteristics was associated with a greater rise in utilization after sepsis.

Conclusions: Veterans surviving sepsis experience high rates of post-sepsis mortality and significant increases in healthcare facility use. Recent nursing facility use is strongly predictive of greater post-sepsis healthcare utilization.

Figure 1

Healthcare Facility Use and Mortality in the Year Before and After Sepsis Hospitalization, Overall and by Subgroups This figure shows the daily location of 26,591 sepsis survivors in the year after sepsis hospitalization. The index sepsis hospitalization is not included; the year after begins the day after hospital discharge. Patients are depicted as being at home (blue), admitted to a hospital (red), admitted to an LTAC or nursing facility (orange), or dead (black).