Abstract
BackgroundPost-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes.MethodsRetrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure.ResultsA total of 830,721 patients in the cohort were hospitalized for sepsis, with inpatient mortality of 20% and 90-day mortality of 48%. Higher hospital-specific sepsis risk-adjusted mortality was associated with increased 90-day post-discharge mortality (aOR 1.03 per each 0.1 increase in hospital inpatient O:E ratio, 95% CI 1.03–1.04). Higher inpatient risk adjusted mortality was also associated with increased probability of being discharged to a nursing facility (aOR 1.03, 95% CI 1.02–1.03) and 90-day readmissions (aOR 1.03, 95% CI 1.02–1.03).ConclusionsHospitals with the highest risk-adjusted sepsis inpatient mortality also have higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications are a modifiable risk that may be affected during inpatient care. Future work will seek to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
Highlights
Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear
All cases were followed for 6 months after hospital admission, with deaths from any cause captured through June 30, 2015 for the last-enrolling patients, and readmissions for any cause censored on December 31, 2014 due to the years of Outpatient and Medicare Provider Analysis and Review (MedPAR) data available
A total of 830,720 age-qualifying Medicare beneficiaries were hospitalized for sepsis between 2013 and 2014 (Fig. 2)
Summary
Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality have high post-discharge mortality, readmissions, and discharge to nursing homes. Sepsis is a life-threatening condition that affects 1.7 million Americans annually, with an in-hospital mortality of 16% [1]. Treatment has been shown to improve survival to hospital discharge [1, 3, 4], but sepsis case-fatality continues to vary significantly by hospital (41% for highest-mortality decile of hospitals vs 29% for lowest-mortality decile, p < 0.001) [5]. The burden of sepsis continues beyond hospital discharge. Readmissions after discharge are common (21% within 30 days) [11], and sepsis survivors have increased post-discharge mortality [12,13,14]. Postdischarge deaths have been associated with premorbid health status and hospital factors [15, 16], but it is unclear whether these factors are modifiable, and whether hospital care can alter the post-discharge course
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