Frequency of and Risk Factors for Increased Healthcare Utilization After Pediatric Sepsis Hospitalization

Abstract

Objectives: To determine the frequency of and risk factors for increased post-sepsis healthcare utilization compared with pre-sepsis healthcare utilization. Design: Retrospective observational cohort study. Setting: Years 2016–2019 MarketScan Commercial and Medicaid Database. Patients: Children (0–18 yr) with sepsis treated in a U.S. hospital. Interventions: None. Measurements and Main Results: We measured the frequency of and risk factors for increased healthcare utilization in the 90 days post- vs. pre-sepsis hospitalization. We defined increased healthcare utilization as an increase of at least 3 days in the 90 days post-hospitalization compared with the 90 days pre-hospitalization based on outpatient, emergency department, and inpatient hospitalization. We identified 2801 patients hospitalized for sepsis, of whom 865 (30.9%) had increased healthcare utilization post-sepsis, with a median (interquartile range [IQR]) of 3 days (1–6 d) total in the 90 days pre-sepsis and 10 days (IQR, 6–21 d) total in the 90 days post-sepsis (p < 0.001). In multivariable models, the odds of increased healthcare use were higher for children with longer lengths of hospitalization (> 30 d adjusted odds ratio [aOR], 4.35; 95% CI, 2.99-6.32) and children with preexisting complex chronic conditions, specifically renal (aOR, 1.47; 95% CI, 1.02–2.12), hematologic/immunologic (aOR, 1.34; 95% CI, 1.03–1.74), metabolic (aOR, 1.39; 95% CI, 1.08–1.79), and malignancy (aOR, 1.89; 95% CI, 1.38–2.59). Conclusions: In this nationally representative cohort of children who survived sepsis hospitalization in the United States, nearly one in three had increased healthcare utilization in the 90 days after discharge. Children with hospitalizations longer than 30 days and complex chronic conditions were more likely to experience increased healthcare utilization.