Factors Associated with 30-day Unplanned Readmissions of Sepsis Patients: A Retrospective Analysis of Patients Admitted with Sepsis at a Community Hospital

Abstract

Introduction Mortality from sepsis is decreasing in recent years owing to improved quality of care, targeted programs, and the implementation of sepsis bundles. This has led to an increased pool of sepsis survivors at risk of readmissions. Studies have shown that these sepsis readmissions are common and expensive. The factors associated with these readmissions remain elusive and have incited a lot of research in recent years. The 30-day sepsis readmission rate is increasingly being used as a quality metric for hospitals. A conducted a retrospective chart review analysis of patients admitted with sepsis to find factors affecting the 30-day readmissions of sepsis survivors. Methods Patients admitted to our hospital either on the medical-surgical floor or in the intensive care unit (ICU) with an administrative coding for sepsis between January 2014 to November 2015 were identified. A literature search, as well as expert opinion, was considered for the list of factors to be studied, including age, sex, residence on admission, length of stay, getting hemodialysis, hospitalization in the prior year, presence of acute kidney injury (AKI), source of sepsis, discharge disposition, receipt of red blood cell (RBC) products, and route of antibiotics on discharge. A univariate binary logistic regression analysis was performed to test the association between the above-mentioned variables and sepsis readmission. Variables with statistical significance in the univariate analysis were used to compute the multivariate regression analysis along, with adjusted OR and their 95% CI.

Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

“…Some studies have only included severe sepsis or septic shock patients [ 8 , 15 , 20 ], or ICU patients [ 23 ]. Readmission rates after 30 or 90 days are typical outcome measures, 30 days being the most commonly used in previous research [ 7 , 16 , 17 , 19 , 21 – 24 ]. Many studies are based on hospital registry data [ 18 , 19 , 21 , 23 ], or on claims data [ 7 , 15 , 16 , 19 , 20 , 24 ].…”

“…Several predictors for readmission have been identified in previous studies: age [ 8 , 17 , 18 ], male gender [ 8 ], black race [ 8 , 17 ], lower income [ 17 ], urban residence [ 17 ], non-elective index admission type [ 18 ], sources of payment for hospital stay [ 7 , 8 , 15 ], number of procedures during the index admission [ 18 ], ICU admission [ 19 ], severity of illness [ 15 , 19 ], acute kidney failure [ 23 ], comorbid disease burden [ 15 , 17 , 19 , 22 , 23 ], diabetes [ 8 , 22 ], chronic kidney disease [ 8 , 22 ], chronic liver disease [ 8 ], chronic lung disease [ 8 ], congestive heart failure [ 22 ], collagen vascular disease [ 8 ], specific infectious agents [ 23 ], care facility after discharge [ 8 , 21 , 22 ], length of stay [ 8 , 15 , 19 , 22 ], annual sepsis case volume [ 8 ], hospital sepsis mortality rate [ 8 , 24 ], teaching hospital status [ 24 ], hospital quality metrics [ 24 ], low hemoglobin [ 18 , 21 ], and high red cell distribution width [ 18 ].…”

Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis

“…Ten studies report a sepsis cohort starting from their index admission [27,35,37,41,44,46,50,51,53,55], twelve studies report a sepsis survivor cohort [9, 12, 30-32, 36, 45, 47, 52, 56, 58, 59], and four report a rehospitalisation cohort [28,34,40,42]. Ten were single-centre studies [28,37,40,44,47,50,51,55,56,59] with greater risk of bias compared to 21 studies [9, 12, 13, 27, 29-31, 33, 35, 36, 38, 39, 41, 42, 45, 48, 49, 53, 54, 57] that used large multi-centre databases with greater generalizability. Five studies that use notes review for outcome assessment [28,37,40,51,55] have a greater risk of ascertainment bias, compared to studies that use record linkage outcome assessment.…”

“…Ten were single-centre studies [28,37,40,44,47,50,51,55,56,59] with greater risk of bias compared to 21 studies [9, 12, 13, 27, 29-31, 33, 35, 36, 38, 39, 41, 42, 45, 48, 49, 53, 54, 57] that used large multi-centre databases with greater generalizability. Five studies that use notes review for outcome assessment [28,37,40,51,55] have a greater risk of ascertainment bias, compared to studies that use record linkage outcome assessment. The primary outcome was all-cause rehospitalisation in 21 studies [9, 12, 13, 28-30, 35, 36, 38, 39, 41, 42, 45, 47, 48, 50-52, 56, 57, 59].…”

Patient Factors Linked with Return Acute Healthcare Use in Older Adults by Discharge Disposition

“…We did not measure whether patients were receiving end‐of‐life care, which may have lowered risk. Patients discharged with septicemia to a facility may have received more intense monitoring and consistent antibiotic administration, thus preventing reinfection, the most common reason for readmission among sepsis survivors 32 . Alternatively, patients may have had an infectious disease associated with lower rehospitalization risk.…”