Document Type
Article
Publication Date
10-27-2020
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.
Recommended Citation
Mohr, Nicholas M.; Zebrowski, Alexis M.; Gaieski, David F.; Buckler, David G.; and Carr, Brendan G., "Inpatient hospital performance is associated with post-discharge sepsis mortality." (2020). Department of Emergency Medicine Faculty Papers. Paper 123.
https://jdc.jefferson.edu/emfp/123
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
33109211
Language
English
Comments
This article is the author’s final published version in Critical Care, Volume 24, Issue 1, December 2020, Article number 626.
The published version is available at https://doi.org/10.1186/s13054-020-03341-3. Copyright © Mohr et al.