Journal article
Inpatient hospital performance is associated with post-discharge sepsis mortality
Critical care (London, England), Vol.24(1), pp.1-626
10/27/2020
DOI: 10.1186/s13054-020-03341-3
PMCID: PMC7592563
PMID: 33109211
Abstract
Background: 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 also have high post-discharge mortality, readmissions, and discharge to nursing homes. Methods: Retrospective 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. Results: A 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). Conclusions: Hospitals 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.
Details
- Title: Subtitle
- Inpatient hospital performance is associated with post-discharge sepsis mortality
- Creators
- Nicholas M. Mohr - Roy J. and Lucille A. Carver College of MedicineAlexis M. Zebrowski - Thomas Jefferson UniversityDavid F. Gaieski - Thomas Jefferson UniversityDavid G. Buckler - Thomas Jefferson UniversityBrendan G. Carr - Sinai University
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.24(1), pp.1-626
- DOI
- 10.1186/s13054-020-03341-3
- PMID
- 33109211
- PMCID
- PMC7592563
- NLM abbreviation
- Crit Care
- ISSN
- 1364-8535
- eISSN
- 1466-609X
- Publisher
- BioMed Central
- Grant note
- R01HL141841 / ; R01HS023614; K08HS025753 / ;
- Language
- English
- Date published
- 10/27/2020
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984296152902771
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