By Will Boggs MD

January 27, 2017

NEW YORK (Reuters Health) – Unplanned 30-day readmissions are common after sepsis hospitalizations, according to data from the Nationwide Readmissions Database.

"The most interesting finding is that sepsis is the leading cause of 30-day readmissions in the U.S.,” Dr. Sachin Yende from VA Pittsburgh Healthcare System in Pennsylvania told Reuters Health by email. “Furthermore, readmissions following sepsis also cost more compared to readmissions following heart failure, heart attack, COPD, and pneumonia. Thus, sepsis accounts for a significant proportion of costs of readmissions.”

As part of its pay-for-performance program, the Centers for Medicare & Medicaid Services tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, COPD, and pneumonia, but not sepsis. The proportion and cost of unplanned readmissions following sepsis hospitalization were unknown until now.

To investigate, Dr. Yende and colleagues used data from the 2013 Nationwide Readmissions Database.

Sepsis accounted for 12.2% of the more than 1.1 million unplanned 30-day readmissions, far more than readmissions after hospitalizations for AMI (1.3%), heart failure (6.7%), COPD (4.6%), or pneumonia (5.0%).

Sepsis patients commonly had additional diagnoses, including AMI (0.7%), heart failure (3.4%), COPD (3.3%), and pneumonia (7.5%), the researchers report in JAMA, online January 22.

Durations of unplanned readmissions were longer following sepsis hospitalization than readmissions following AMI, heart failure, COPD, and pneumonia, and the estimated mean cost per readmission was significantly higher for sepsis ($10,070) than for AMI ($9424), heart failure ($9051), COPD ($8417), or pneumonia ($9533).

“There are recent studies showing that since the hospital readmission reduction program (HRRP) started, readmissions for heart failure, COPD, pneumonia, and heart attack have decreased,” Dr. Yende said.

“Whether adding sepsis readmissions to HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions (e.g., infections) and that most patients would prefer to avoid admission to the hospital,” he said.

“Although sepsis is an acute condition, it has long-term sequelae that last long after hospital discharge,” he concluded. “Thus, providers should consider developing programs/interventions to reduce these sequelae.”

Dr. Hallie Prescott from the University of Michigan Health System and VA Ann Arbor Healthcare System told Reuters Health by email, “We also know that a high proportion of these readmissions after sepsis are potentially preventable - suggesting that there may be an opportunity for improvement.”

“When treating sepsis survivors in clinic after hospitalization, we should focus our attention to common, treatable conditions that account for many of these readmissions - such as recurrent infection, heart failure exacerbation, renal failure, and aspiration,” said Dr. Prescott, an expert in pulmonary and critical care, who was not involved in the study.

Dr. Faheem Guirgis, an emergency physician at the University of Florida’s UF Health Jacksonville, said, “Sepsis is a big problem, and one of the most difficult and common conditions faced by healthcare providers and policy makers. Contributing to the challenge is the lack of gold-standard diagnostic tests for making the diagnosis, changing definitions, and the complexity of taking care of septic patients.”

“Furthermore, as the population grows older, and as the chronic disease burden of the general population increases, patients become more susceptible to sepsis,” he told Reuters Health by email. “Elderly patients, patients on hemodialysis and chemotherapy, the more times they access a healthcare facility the higher their risk of infection, and thus the higher their risk of sepsis. It's almost a consequence of advanced care that allows people to live longer with more medical conditions.”

“I think prevention is one key, but there are going to be many other pieces to this puzzle,” said Dr. Guirgis, who also was not involved study.

“Sepsis should not be viewed as a one-and-done phenomenon,” said Dr. Mark E. Mikkelsen, chief of medical critical care at Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

“As many as one in four sepsis survivors are readmitted within 30 days, many with a recurrent life-threatening infection,” he told Reuters Health by email. “Arming patients with this knowledge is key, so that patients and clinicians can detect and treat new or recurrent infections in a timely manner after sepsis.”

“This study supports that the hospital readmission reduction program should add sepsis to their targeted conditions,” said Dr. Mikkelsen, who was not part of the research.

SOURCE: https://bit.ly/2kiwjtn

JAMA 2017.

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