Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

Abstract

Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p < 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.

Cuidados De Enfermagem a Sobreviventes De Sepse Após a Alta Da Uti

“…OR UTI OR "intensive care unit" OR "intensive care units" OR "intensive care" OR ICU) AND (sepse OR "sepse grave" OR septicemia* OR sepsis OR septic OR "post sepsis" OR "after sepsis"). A síntese dos estudos incluídos nesta revisão sistemática foi apresentada nos Quadros 2 a 7 (Schmidt et al, 2016;Schmidt et al, 2020;Schmidt et al, 2022;Fleischmann-Struzek et al, 2021;Downer et al, 2021;Ehlenbach et al, 2018)…”

“…Os estudos mostraram que os sobreviventes de sepse que foram internados em UTI apresentam diversos comprometimentos após a alta, incluindo AVD prejudicadas, incapacidades motoras e cognitivas (Schmidt et al, 2016;Ehlenbach et al, 2018;Schmidt et al, 2020;Downer et al, 2021;Fleischmann-Struzek et al, 2021;Schmidt et al, 2022). O comprometimento físico está associado a perda de massa muscular durante a sepse e regeneração muscular prejudicada após a doença, e a disfunção cognitiva pode estar relacionada a danos induzidos por inflamação cerebral e isquemia, o que diminui a qualidade de vida e contribui para rehospitalização (van der Slikke et al, 2020).…”

“…Os pacientes com sepse grave e aqueles tratados em UTI apresentaram maior taxa de mortalidade, e os gastos dos sobreviventes com cuidados de saúde após a alta também foram elevados (Fleischmann-Struzek et al, 2021). Um dos estudos identificou, ainda, que seis meses após a alta 60% dos pacientes foram readmitidos pelo menos uma vez (Schmidt et al, 2022) doenças crônicas (Prescott et al, 2014;Mostel et al, 2020;van der Slikke et al, 2020).…”

“…A participação ativa da enfermagem nos cuidados foi pouco descrita nos estudos encontrados, porém a necessidade desses cuidados foi identificada. Um estudo observacional identificou que 16% dos pacientes precisavam de cuidados de enfermagem três meses antes da sepse, comparado a 56% seis meses após a alta da UTI (Schmidt et al, 2022). No estudo de Fleischmann-Struzek e colaboradores (2021), a presença de nova dependência de enfermagem foi maior nos pacientes sobreviventes de sepse grave e tratados em UTI, e ao total 19,3% dos sobreviventes sem doenças préexistentes precisaram de novos cuidados de enfermagem.…”

Post-Intensive Care Syndrome—10 Years after Its Proposal and Future Directions

“…Sepsis survivors have a high prevalence of PTSD. Sepsis survivors have high healthcare utilization and related costs that persist after discharge from the hospital [ 22 ]. Since this economic impact after severe illness is one of the causes of PICS mental disorders and PICS-F, the establishment of financial support should be needed in the future.…”