Sepsis-Associated 30-Day Risk-Standardized Readmissions: Analysis of a Nationwide Medicare Sample

Sepsis-Associated 30-Day Risk-Standardized Readmissions: Analysis of a Nationwide Medicare Sample
Norman, B et al
Critical Care Medicine: July 2017 - Volume 45 - Issue 7 - p 1130–1137

Objectives: To determine national readmission rates among sepsis survivors, variations in rates between hospitals, and determine whether measures of quality correlate with performance on sepsis readmissions. Design: Cross-sectional study of sepsis readmissions between 2008 and 2011 in the Medicare fee-for-service database. Setting: Acute care, Medicare participating hospitals from 2008 to 2011. Patients: Septic patients as identified by International Classification of Diseases, Ninth Revision codes using the Angus method. Interventions: None. Measurements and Main Results: We generated hospital-level, risk-standardized, 30-day readmission rates among survivors of sepsis and compared rates across region, ownership, teaching status, sepsis volume, hospital size, and proportion of underserved patients. We examined the relationship between risk-standardized readmission rates and hospital-level composite measures of quality and mortality. From 633,407 hospitalizations among 3,315 hospitals from 2008 to 2011, median risk-standardized readmission rates was 28.7% (interquartile range, 26.1–31.9). There were differences in risk-standardized readmission rates by region (Northeast, 30.4%; South, 29.6%; Midwest, 28.8%; and West, 27.7%; p < 0.001), teaching versus nonteaching status (31.1% vs 29.0%; p < 0.001), and hospitals serving the highest proportion of underserved patients (30.6% vs 28.7%; p < 0.001). The best performing hospitals on a composite quality measure had highest risk-standardized readmission rates compared with the lowest (32.0% vs 27.5%; p < 0.001). Risk-standardized readmission rates was lower in the highest mortality hospitals compared with those in the lowest (28.7% vs 30.7%; p < 0.001). Conclusions: One third of sepsis survivors were readmitted and wide variation exists between hospitals. Several demographic and structural factors are associated with this variation. Measures of higher quality in-hospital care were correlated with higher readmission rates. Several potential explanations are possible including poor risk standardization, more research is needed.

Association Between Index Hospitalization and Hospital Readmission in Sepsis Survivors

Association between Index Hospitalization and Hospital Readmission in Sepsis Survivors

Critical Care Medicine March 2016 - Volume 44 - Issue 3 - p 478–487

Sun A et al
Objectives: Hospital readmission is common after sepsis, yet the relationship between the index admission and readmission remains poorly understood. We sought to examine the relationship between infection during the index acute care hospitalization and readmission and to identify potentially modifiable factors during the index sepsis hospitalization associated with readmission. Design: In a retrospective cohort study, we evaluated 444 sepsis survivors at risk of an unplanned hospital readmission in 2012. The primary outcome was 30-day unplanned hospital readmission. Setting: Three hospitals within an academic healthcare system. Subjects: Four hundred forty-four sepsis survivors. Measurements and Main Results: Of 444 sepsis survivors, 23.4% (95% CI, 19.6–27.6%) experienced an unplanned 30-day readmission compared with 10.1% (95% CI, 9.6–10.7%) among 11,364 nonsepsis survivors over the same time period. The most common cause for readmission after sepsis was infection (69.2%, 72 of 104). Among infection-related readmissions, 51.4% were categorized as recurrent/unresolved. Patients with sepsis present on their index admission who also developed a hospital-acquired infection (“second hit”) were nearly twice as likely to have an unplanned 30-day readmission compared with those who presented with sepsis at admission and did not develop a hospital-acquired infection or those who presented without infection and then developed hospital-acquired sepsis (38.6% vs 22.2% vs 20.0%, p = 0.04). Infection-related hospital readmissions, specifically, were more likely in patients with a “second hit” and patients receiving a longer duration of antibiotics. The use of total parenteral nutrition (p = 0.03), longer duration of antibiotics (p = 0.047), prior hospitalizations, and lower discharge hemoglobin (p = 0.04) were independently associated with hospital readmission. Conclusions: We confirmed that the majority of unplanned hospital readmissions after sepsis are due to an infection. We found that patients with sepsis at admission who developed a hospital-acquired infection, and those who received a longer duration of antibiotics, appear to be high-risk groups for unplanned, all-cause 30-day readmissions and infection-related 30-day readmissions.

Critical care transition programs and the risk of readmission or death after discharge from an ICU

Critical care transition programs and the risk of readmission or death after discharge from an ICU: A systematic review and meta-analysis. Critical care medicine, Jan 2014, Vol. 42(1), p.179-87.

Niven, D.J., et al.

http://journals.lww.com/ccmjournal/Abstract/2014/01000/Critical_Care_Transition_Programs_and_the_Risk_of.21.aspx

To determine whether critical care transition programs reduce the risk of ICU readmission or death, when compared with standard care among adults who survived their incident ICU admission.

Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensiv

Surgery Today. 2009;39(4):295-9. Epub 2009 Mar 25. LinkOut
Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit.
Chan KS, Tan CK, Fang CS, Tsai CL, Hou CC, Cheng KC, Lee MC.
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan.

PURPOSE: To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU).

METHODS: The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003.

RESULTS: Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 +/- 7.17 vs 5.22 +/- 4.95, P < p =" 0.049)." p =" 0.001)" p =" 0.010).">

CONCLUSION: The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.
PMID: 19319635 [PubMed - in process]

The effect of comorbidities on risk of intensive care readmission during the same hospitalization: a linked data cohort study

The effect of comorbidities on risk of intensive care readmission during the same hospitalization: a linked data cohort study.
Ho KM, Dobb GJ, Lee KY, Finn J, Knuiman M, Webb SA.
J Crit Care. 2009 Mar;24(1):101-7. Epub 2008 Apr 18.PMID: 19272545 [PubMed - in process]Related Articles

Readmission to a surgical intensive care unit: incidence, outcome and risk factors.

p. R123
Kaben, A.; Corrêa, F.; Reinhart, K.; Settmacher, U.; Gummert, J.; Kalff, R.; Sakr, Y.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=PM018838006&field=zid

Readmission to a surgical intensive care unit: incidence, outcome, and risk factors

Readmission to a surgical intensive care unit: incidence, outcome, and risk factors
Kaben A, Correa F, Reinhart K, Settmacher U, Gummert J, Kalff R, Sakr YCritical Care, 2008 12:R123 ( 6 October 2008 )[Abstract] [Provisional PDF]

Predicting death and readmission after intensive care discharge

Campbell AJ, Cook JA, Adey G, Cuthbertson BH.
Department of Anaesthesia, Western Infirmary, Glasgow G11 6NT, UK. alison.campbell3@nhs.net

BACKGROUND: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.

METHODS: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU. RESULTS: Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.

CONCLUSIONS: We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.