Increased 1-Year Healthcare Use in Survivors of Severe Sepsis

TitleIncreased 1-Year Healthcare Use in Survivors of Severe Sepsis
Publication TypeJournal Article
Year of Publication2014
AuthorsPrescott, HC, Langa, KM, Liu, V, Escobar, GJ, Iwashyna, TJ
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume190
Issue1
Pagination62-69
KeywordsHealth Conditions and Status, Healthcare
Abstract

Rationale: Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors' post-discharge healthcare use. Objectives: To measure inpatient healthcare use of severe sepsis survivors compared with patients' own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations. Methods: This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998-2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use. Measurements and Main Results: Using Medicare claims, we measured patients' use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 interquartile range, 3-45 vs. 7 0-29 ; P 0.001) and a higher proportion of days alive (median, 9.6 interquartile range, 1.4-33.8 vs. 1.9 0.0-7.9 ; P 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2 95 confidence interval, 41.3-47.2 vs. 31.4 95 confidence interval, 28.6-34.2 at 1 year), a steeper decline in days spent at home (difference-in-differences, -38.6 d 95 confidence interval, -50.9 to 26.3 ; P 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4 95 confidence interval, 2.8-8.1 ; P 0.001). Conclusions: Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.

Notes

Times Cited: 1

DOI10.1164/rccm.201403-0471OC
Endnote Keywords

healthcare facilities/sepsis/hospitalization/patient outcomes assessment/patient readmission/skilled nursing facility

Endnote ID

999999

Citation Key8115
PubMed ID24872085
PubMed Central IDPMC4226030