Jones Tiffanie K, Fuchs Barry D, Small Dylan S, Halpern Scott D, Hanish Asaf, Umscheid Craig A, Baillie Charles A, Kerlin Meeta Prasad, Gaieski David F, Mikkelsen Mark E
1 Department of Medicine.
2 Division of Pulmonary, Allergy, and Critical Care.
Ann Am Thorac Soc. 2015 Jun;12(6):904-13. doi: 10.1513/AnnalsATS.201411-504OC.
The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.
To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis.
In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.
Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.
Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.
脓毒症后急性后期护理的使用情况及医院再入院的流行病学情况在很大程度上仍不为人所知。
研究脓毒症后急性后期护理的使用率及医院再入院情况，并探讨脓毒症后医院再入院的危险因素及转归。
在一项于学术性医疗保健系统中开展的观察性队列研究（2010 - 2012年）中，我们将3620例脓毒症住院病例与108958例非脓毒症住院病例在出院时的急性后期护理使用情况及3次医院再入院情况进行了比较。我们采用了三种经过验证的基于索赔的方法来识别脓毒症和严重脓毒症。
脓毒症后出院时更有可能使用急性后期护理，这是由专业护理机构安置所驱动的（脓毒症后为35.4%，而非脓毒症为15.8%；P < 0.001），在严重脓毒症后观察到的发生率最高。脓毒症后7天、30天和90天的再入院率更高（P < 0.001）。与非脓毒症住院病例（30天内15.6%再入院）相比，无论脓毒症严重程度如何，再入院风险均增加（脓毒症后为27.3%，严重脓毒症后为26.0 - 26.2%）。在控制了脓毒症前的特征后，发现再入院风险比非脓毒症住院病例高1.51倍（95%CI，1.38 - 1.66）。脓毒症后的再入院更有可能导致死亡或转至临终关怀护理（脓毒症后为6.1%，而非脓毒症后为13.3%；P < 0.001）。与脓毒症住院后30天再入院相关的独立危险因素包括年龄、恶性肿瘤诊断、本次住院前一年的住院次数、非选择性本次住院类型、本次住院期间进行的一项或多项手术，以及出院时低血红蛋白和高红细胞分布宽度。
脓毒症后急性后期护理的使用及医院再入院情况很常见。无论脓毒症严重程度如何，脓毒症后的再入院风险均增加，且与不良再入院转归相关。
