Goodwin Andrew J, Rice David A, Simpson Kit N, Ford Dee W
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC. 2Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, SC.
Crit Care Med. 2015 Apr;43(4):738-46. doi: 10.1097/CCM.0000000000000859.
To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis.
Observational cohort study of Healthcare Cost and Utilization Project data.
All nonfederal hospitals in three U.S. states.
Severe sepsis survivors (n = 43,452) in the first two quarters of 2011.
None.
We measured readmission rates and the associated cost and mortality of readmissions in severe sepsis survivors. We used multivariable logistic regression to identify patient and hospitalization characteristics associated with readmission. Of 43,452 sepsis survivors, 26% required readmission within 30 days and 48% within 180 days. The cumulative mortality rate of sepsis survivors attributed to readmissions was 8%, and the estimated cost was over $1.1 billion. Among survivors, 25% required multiple readmissions within 180 days and accounted for 77% of all readmissions. Age younger than 80 years (odds ratio, 1.14; 95% CI, 1.08-1.21), black race (odds ratio, 1.18; 95% CI, 1.10-1.26), and Medicare or Medicaid payor status (odds ratio, 1.21; 95% CI, 1.13-1.30; odds ratio, 1.34; 95% CI, 1.23-1.46, respectively) were associated with greater odds of 30-day readmission while female gender was associated with reduced odds (odds ratio, 0.92; 95% CI, 0.87-0.96). Comorbidities including malignancy (odds ratio, 1.34; 95% CI, 1.24-1.45), collagen vascular disease (odds ratio, 1.30; 95% CI, 1.15-1.46), chronic kidney disease (odds ratio, 1.24; 95% CI, 1.18-1.31), liver disease (odds ratio, 1.22; 95% CI, 1.11-1.34), congestive heart failure (odds ratio, 1.14; 95% CI, 1.08-1.19), lung disease (odds ratio, 1.12; 95% CI, 1.06-1.18), and diabetes (odds ratio, 1.12; 95% CI, 1.07-1.17) were associated with greater odds of 30-day readmission. Index hospitalization characteristics including longer length of stay, discharge to a care facility, higher hospital annual severe sepsis case volume, and higher hospital sepsis mortality rate were also positively associated with readmission rates.
The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates.
确定严重脓毒症首次住院后再入院的频率、死亡率、成本及相关风险因素。
对医疗成本与利用项目数据进行的观察性队列研究。
美国三个州的所有非联邦医院。
2011年前两个季度的严重脓毒症幸存者（n = 43452）。
无。
我们测量了严重脓毒症幸存者的再入院率以及再入院相关的成本和死亡率。我们使用多变量逻辑回归来确定与再入院相关的患者及住院特征。在43452名脓毒症幸存者中，26%在30天内需要再次入院，48%在180天内需要再次入院。因再入院导致的脓毒症幸存者累积死亡率为8%，估计成本超过11亿美元。在幸存者中，25%在180天内需要多次再入院，占所有再入院的77%。80岁以下（比值比，1.14；95%可信区间，1.08 - 1.21）、黑人种族（比值比，1.18；95%可信区间，1.10 - 1.26）以及医疗保险或医疗补助支付者状态（比值比分别为1.21；95%可信区间，1.13 - 1.30；1.34；95%可信区间，1.23 - 1.46）与30天再入院的较高几率相关，而女性性别与较低几率相关（比值比，0.92；95%可信区间，0.87 - 0.96）。包括恶性肿瘤（比值比，1.34；95%可信区间，1.24 - 1.45）、胶原血管病（比值比，1.30；95%可信区间，1.15 - 1.46）、慢性肾病（比值比，1.24；95%可信区间，1.18 - 1.31）、肝病（比值比，1.22；95%可信区间，1.11 - 1.34）、充血性心力衰竭（比值比，1.14；95%可信区间，1.08 - 1.19）、肺病（比值比，1.12；95%可信区间，1.06 - 1.18）和糖尿病（比值比，1.12；95%可信区间，1.07 - 1.17）在内的合并症与30天再入院的较高几率相关。首次住院特征包括住院时间较长、出院至护理机构、医院年度严重脓毒症病例数较多以及医院脓毒症死亡率较高也与再入院率呈正相关。
30天和180天再入院在脓毒症幸存者中很常见，会导致显著的成本和死亡率。患者的社会人口统计学和合并症以及首次住院特征与30天再入院率相关。
