Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level

Abstract

Objectives: To characterize the current burden, outcomes, and costs of managing sepsis patients in U.S. hospitals.

Design: A retrospective observational study was conducted using the Premier Healthcare Database, which represents ~20% of U.S. inpatient discharges among private and academic hospitals. Hospital costs were obtained from billing records per the cost accounting method used by each hospital. Descriptive statistics were performed on patient demographics, characteristics, and clinical and economic outcomes for the index hospitalization and 30-day readmissions.

Setting: Sepsis patient hospitalizations, including inpatient, general ward, and ICU (intermediate and/or step-down).

Patients: Adults over 18 years old with a hospital discharge diagnosis code of sepsis from January 1, 2010, to September 30, 2016.

Interventions: None. This was a retrospective observational study of deidentified data.

Measurements and main results: The final study cohort consisted of 2,566,689 sepsis cases, representing patients with a mean age of 65 years (50.8% female). Overall mortality was 12.5% but varied greatly by severity (5.6%, 14.9%, and 34.2%) for sepsis without organ dysfunction, severe sepsis, and septic shock, respectively. Costs followed a similar pattern increasing by severity level: $16,324, $24,638, and $38,298 and varied widely by sepsis present at admission ($18,023) and not present at admission ($51,022).

Conclusions: The highest burden of incidence and total costs occurred in the lowest severity sepsis cohort population. Sepsis cases not diagnosed until after admission, and those with increasing severity had a higher economic burden and mortality on a case-by-case basis. Methods to improve early identification of sepsis may provide opportunities for reducing the severity and economic burden of sepsis in the United States.

Figure 1.

Attrition diagram for inpatient sepsis hospitalizations included for analysis. ICD-9/10 = International Classification of Diseases, 9/10th Edition, MS-DRG = Medicare Severity Diagnosis Related Groups.

Figure 2.

Distribution of bacteria detected among inpatient sepsis hospitalizations.