Prescott Hallie C
1 VA Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and.
2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Ann Am Thorac Soc. 2017 Feb;14(2):230-237. doi: 10.1513/AnnalsATS.201605-398OC.
Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations.
To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries.
Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 vs. ≥65 yr), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital. In the primary analysis, sepsis hospitalizations were identified using a previously validated method. Sensitivity analyses were performed using alternative definitions with explicit International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sepsis, and separately for severe sepsis and septic shock.
The primary outcomes were rate of 90-day all-cause hospital readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of "potentially preventable" readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, and chronic obstructive pulmonary disease) accounted for 30% of all readmissions. Although about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounted for a greater proportion of readmissions among patients discharged to nursing facilities compared with patients discharged to home (25.0-27.1% vs. 16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common among older patients and patients discharged to nursing facilities.
Hospital readmission rates after sepsis were similar by site and admission year. Heart failure, pneumonia, sepsis, and urinary tract infection were common readmission diagnoses across all patient groups. Readmission for infection and potentially preventable diagnoses were more common in older patients and patients discharged to nursing facilities.
脓毒症后再入院情况常见，但对于不同患者群体和护理地点的再入院模式差异知之甚少。
研究美国退伍军人事务部（VA）受益人群中，脓毒症后再入院率及诊断情况因患者年龄、护理机构使用情况、入院年份和医院的差异。
对在114家VA医院因脓毒症住院存活（2009 - 2011年）的VA受益人群进行观察性队列研究，按年龄（<65岁与≥65岁）、疗养院使用情况（无、慢性或急性）、入院年份（2009年、2010年、2011年）和医院分层。在主要分析中，使用先前验证的方法识别脓毒症住院病例。使用明确的《国际疾病分类，第九版，临床修订本》脓毒症编码以及分别针对严重脓毒症和脓毒性休克的替代定义进行敏感性分析。
主要结局指标为脓毒症住院后90天全因再入院率以及特定诊断导致的再入院比例，包括“潜在可预防”再入院比例。2009年至2011年再入院诊断相似，各医院再入院率变化不大。前六大再入院诊断（心力衰竭、肺炎、脓毒症、尿路感染、急性肾衰竭和慢性阻塞性肺疾病）占所有再入院病例的30%。尽管约五分之一的再入院病例主要诊断为感染，但所有再入院病例中有58%接受了早期全身性抗生素治疗。与出院回家的患者相比，入住护理机构的患者再入院病例中感染所占比例更高（25.0 - 27.1%对16.8%），老年患者比年轻患者更高（22.2%对15.8%）。潜在可预防的再入院病例占总体再入院病例的四分之一，在老年患者和入住护理机构的患者中更为常见。
脓毒症后的医院再入院率因地点和入院年份相似。心力衰竭、肺炎、脓毒症和尿路感染是所有患者群体常见的再入院诊断。感染再入院和潜在可预防诊断在老年患者和入住护理机构的患者中更为常见。
