Inpatient hospital performance is associated with post-discharge sepsis mortality

Critical Care

David F. Gaieski¹  Alexis M. Zebrowski¹  David G. Buckler¹  Nicholas M. Mohr²  Brendan G. Carr³ 

[1] Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA;Department of Emergency Medicine, University of Iowa Carver College of Medicine, 1008 RCP, 200 Hawkins Drive, 52242, Iowa City, IA, USA;Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA;Mount Sinai University, New York, NY, USA;

关键词: Sepsis;    Quality of health care;    Patient discharge;    Patient readmission;   

DOI  :  10.1186/s13054-020-03341-3

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY