Abstract
BackgroundHospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period.MethodsClinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual eligibility) were controlled for in these models.ResultsIn 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P < 0.01; and pneumonia HR = 1.58, P < 0.01) and the risk persisted throughout the follow-up period. Persons with sepsis and pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death.ConclusionsThe infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.
Highlights
Hospital associated infections are major problems, which are increasing in incidence and very costly
The aim of this study was to examine in Medicare patients admitted to an intensive care unit (ICU) and discharged alive: the relationships between sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and to determine how much of the resource utilization was related to impending death during the follow up period
Thirty-one hospitals from across the United States contributed data on 17,537 subjects who were discharged alive from 51 ICUs
Summary
Hospital associated infections are major problems, which are increasing in incidence and very costly. There is increasing interest in the long-term outcomes associated with sepsis and pneumonia, research in this area is limited [8,9]. In a recent systematic review, 23 studies examining mortality after hospital discharge with diagnosis of sepsis were found [10]; and, only two of the studies followed patients for up to five years and included measures of healthcare utilization [11,12]. The authors of the systematic review concluded patients with sepsis had ongoing mortality up to 2 years and they encouraged researchers to include longer-term endpoints. Researchers examined long-term mortality after hospitalization with pneumonia [13]. We could identify no studies of the long-term clinical consequences of healthcare associated infections
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