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Hospital Readmissions Following Severe Sepsis Often Preventable

More than 40% of severe sepsis survivors readmitted within 90 days

In an analysis of approximately 2,600 hospitalizations for severe sepsis, readmissions within 90 days were common, and approximately 40% occurred for diagnoses that could potentially be prevented or treated early to avoid hospitalization, according to a study in the March 10 issue of JAMA.

Patients are frequently rehospitalized within 90 days after having severe sepsis. Little is known, however, about the reasons for readmission and whether they can be reduced. Hallie C. Prescott, MD, MSc, of the University of Michigan, Ann Arbor, and colleagues examined the most common readmission diagnoses after hospitalization for severe sepsis, the extent to which readmissions may be potentially preventable by post-hospitalization ambulatory care, and whether the pattern of readmission diagnoses differs compared with that of other acute medical conditions.

The study included participants in the nationally representative U.S. Health and Retirement Study, a sample of households with adults 50 years of age or older, that is linked to Medicare claims (1998–2010). For the analysis, the researchers identified 2,617 hospitalizations for severe sepsis, which were matched to hospitalizations for other acute medical conditions. To gauge what proportion of rehospitalizations may be potentially preventable, the authors measured ambulatory care-sensitive conditions (ACSCs). These are diagnoses for which effective outpatient care may reduce hospitalization rates.

A total of 1,115 survivors of severe sepsis (42.6%) were rehospitalized within 90 days. The 10 most common readmission diagnoses following severe sepsis included several ACSCs (e.g., heart failure, pneumonia, chronic obstructive pulmonary disease exacerbation, and urinary tract infection). Collectively, ACSCs accounted for 22% of 90-day readmissions.

Readmissions for a primary diagnosis of infection (i.e., sepsis, pneumonia, urinary tract, and skin or soft-tissue infections) occurred in 12% of severe sepsis survivors compared with 8% of matched acute medical conditions. Readmissions for ACSCs were more common after severe sepsis (22%) compared with matched acute conditions (19%) and accounted for a greater proportion of all 90-day readmissions (42% vs. 37%, respectively).

“The high prevalence and concentration of specific diagnoses during the early post-discharge period suggest that further study is warranted of the feasibility and potential benefit of post-discharge interventions tailored to patients’ personalized risk for a limited number of common conditions,” the authors write.

Sources: JAMA Network; March 10, 2015; and JAMA; March 10, 2015.

 

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