Epidemiology of Readmissions After Sepsis Hospitalization in Children

Abstract

Background and objectives: The decline in hospital mortality in children hospitalized with sepsis has increased the number of survivors. These survivors are at risk for adverse long-term outcomes, including readmission and recurrent or unresolved infections. We described the epidemiology of 90-day readmissions after sepsis hospitalization in children. We tested the hypothesis that a sepsis hospitalization increases odds of 90-day readmissions.

Methods: Retrospective cohort analysis of the Nationwide Readmissions Database. We included index unplanned admissions of non-neonatal pediatric patients and described the proportion of readmissions, including those involving infection or sepsis. We performed multivariable analysis to determine the odds of readmission after a sepsis and nonsepsis admission and compared costs of readmission after sepsis and nonsepsis admissions.

Results: Of 562 817 pediatric admissions, 7634 (1.4%) and 555 183 (98.6%) were discharged alive after admissions with and without sepsis. The rate of 90-day readmission after sepsis was 21.4%: 7.2% and 25.5% in previously healthy and chronically ill patients. The adjusted mean cost during readmission was $7385. Half of readmissions (52.9%) involved recurrent infection or sepsis. Sepsis admissions were associated with higher odds of readmission at 90 days compared with nonsepsis admissions (adjusted odds ratio 1.15, 95% confidence interval 1.08-1.23). The results remained unchanged for 30-day and 6-month readmissions.

Conclusions: Readmissions occur after 1 in 5 pediatric sepsis hospitalizations and increase health care costs. Sepsis hospitalization increased odds of readmission and commonly involved recurrent infection or sepsis. Clinicians caring for these patients should consider surveillance for recurrent or unresolved infection, and researchers should explore underlying mechanisms and potential interventions to reduce readmissions.

FIGURE 1

Enrollment of the primary cohort: cohort selection and inclusion criteria for index admissions with and without sepsis. These admissions were not the first admissions of the year for these patients.

FIGURE 2

Failure plots with time to readmission within primary and matched sensitivity analysis cohorts. A, Failure plots for unadjusted readmission rate after sepsis and nonsepsis admissions in primary unmatched analysis. B, Failure plots for unadjusted readmission rate after sepsis and nonsepsis admissions in less exact matching analysis. C, Failure plots for unadjusted readmission rate after sepsis and nonsepsis admissions in more exact matching analysis. Sepsis admissions are in black, and nonsepsis admissions are in gray.

FIGURE 3

Multivariable models for primary and sensitivity analyses of adjusted odds of readmission after sepsis. Sepsis admissions were associated with higher adjusted odds of readmissions compared with nonsepsis admissions in primary and sensitivity analyses. Adjusted ORs with CIs, number of sepsis cases able to be matched, and cohort size for sensitivity analyses are shown (see text for additional details).