Hospital Readmissions After Severe Sepsis Often Preventable

Laurie Barclay, MD

March 11, 2015

Readmissions within 90 days of hospitalizations for severe sepsis are common, according to a research letter published in the March 10 issue of JAMA. In addition, just more than 40% of the readmissions were for diagnoses that could potentially be prevented or treated early to avoid hospitalization.

"We sought to determine the most common readmission diagnoses after hospitalization for severe sepsis, the extent to which readmissions may be potentially preventable by posthospitalization ambulatory care, and whether the pattern of readmission diagnoses differs compared with that of other acute medical conditions," write Hallie C. Prescott, MD, from the University of Michigan, Ann Arbor, and colleagues.

The investigators analyzed data from the US Health and Retirement Study, a nationally representative sample of households including adults aged at least 50 years, with linkage to Medicare claims from 1998 to 2010. They identified hospitalizations for severe sepsis and matched these to hospitalizations for other acute medical conditions on the basis of age, sex, postdischarge comorbidity, prehospitalization functional disability, and length of hospitalization.

Analysis of allowed determination of what percentage of rehospitalizations could potentially be prevented.

Of 3494 hospitalizations for severe sepsis, 2843 (81.4%) survived to discharge, and 1115 (42.6%) were rehospitalized within 90 days.

When the researchers analyzed the readmissions looking for ambulatory care sensitive conditions (ACSCs), or diagnoses for which effective outpatient care may lower rates of hospitalization, they found that more than one fifth (22.1%; 95% confidence interval [CI], 20.3% - 24.5%) of rehospitalizations were for ACSCs, including heart failure, pneumonia, exacerbation of chronic obstructive pulmonary disease, and urinary tract infection. In comparison, 19.1% (95% CI, 17.7% - 20.7%) of readmissions among patients with other acute medical conditions were for ACSCs (P = .02). ACSCs accounted for several of the 10 most common readmission diagnoses.

Using an expanded definition for ACSCs, they accounted for 41.6% (95% CI, 39.1% - 44.1%) of 90-day readmissions after severe sepsis compared with 37.1% (95% CI, 34.8% - 39.5%; P = .009) for matched patients with other acute medical conditions.

Survivors of severe sepsis also had higher rates of readmission for sepsis, for renal failure, and for any infection (sepsis, pneumonia, urinary tract, and skin or soft tissue infection; 11.9% [95% CI, 10.6% - 13.1%] vs 8.0% [95% CI, 7.0% - 9.1%]; P < .001).

"Readmissions within 90 days after hospitalization for severe sepsis were common, and 42% occurred for diagnoses that could potentially be prevented or treated early to avoid hospitalization compared with 37% after matched acute medical conditions," the authors conclude.

"A limitation of the present study is that we inferred the potential preventability of rehospitalizations by measuring readmissions for ACSCs.... [F]urther study is warranted of the feasibility and potential benefit of postdischarge interventions tailored to patients' personalized risk for a limited number of common conditions."

The National Institutes of Health, Department of Veterans Affairs Health Services Research & Development Service, and National Institute on Aging funded this study. The authors have disclosed no relevant financial relationships.

JAMA. 2015;313:1055-1057. Abstract

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