Department of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States.
Department of Health Administration and Policy, George Mason University, Fairfax, VA, United States.
Resuscitation. 2019 Oct;143:35-41. doi: 10.1016/j.resuscitation.2019.08.007. Epub 2019 Aug 10.
Previous studies have reported regional variation in either the incidence or outcomes of sepsis or In-hospital Cardiac Arrest (IHCA) discretely; however, regional variations in the incidence and outcomes of sepsis-associated IHCA (SA-IHCA) have never been studied.
From the National Inpatient Sample (NIS), discharges with sepsis and sepsis-associated IHCA were identified in 4 geographic regions (Northeast, Midwest, South, West) from 2007 to 2014 using applicable ICD-9-CM codes. We assessed the regional incidence and trends in SA-IHCA and subsequent inpatient outcomes.
Out of 8,058,091 sepsis-related admissions, 187,163 (2.3%) were associated with IHCA with a rising trend in the incidence from 2007- to 2014 (2.0% to 2.6%, p < 0.001). The overall incidence of SA-IHCA was highest in South (2.6%) with the highest mortality in West (74.4%) (p < 0.001). The incidence of SA-IHCA increased in the South (2.4%-3.0%) and Midwest (1.6%-2.4%) from 2007 to 2014. Mortality has not significantly increased or decreased across all regions. Compared with the West, survivors in the Northeast, Midwest, and the South were less likely to be discharged home and were more likely to be transferred to other facilities. In the SA-IHCA cohort, the mean length of stay for SA-IHCA was highest in Northeast (˜10.9 days) and lowest in Midwest (˜8.6 days) (p < 0.001). Hospital charges were highest in the West ($234,278) and lowest in the Midwest ($125,725) (p < 0.001).
This nationwide analysis demonstrates that the highest incidence of SA-IHCA is in the Southern region of the US whereas the associated in-hospital mortality was highest in the West. The incidence of SA-IHCA is rising in the Midwest and South from 2007 to 2014. Despite significant advances in the treatment of sepsis and IHCA, there has been no significant improvement in the incidence of SA-IHCA and subsequent survival in any US geographic region from 2007 to 2014.
之前的研究分别报告了脓毒症或院内心搏骤停（IHCA）的发生率或结局的区域性差异；然而，脓毒症相关 IHCA（SA-IHCA）的发生率和结局的区域性差异从未被研究过。
从 2007 年至 2014 年，利用适用的 ICD-9-CM 代码，从国家住院患者样本（NIS）中确定了四个地理区域（东北部、中西部、南部和西部）的脓毒症和脓毒症相关 IHCA 的出院患者。我们评估了 SA-IHCA 的区域性发生率和趋势以及随后的住院患者结局。
在 8058091 例与脓毒症相关的住院患者中，有 187163 例（2.3%）与 IHCA 相关，其发生率呈上升趋势，从 2007 年到 2014 年从 2.0%上升到 2.6%（p<0.001）。SA-IHCA 的总体发生率在南部最高（2.6%），西部死亡率最高（74.4%）（p<0.001）。2007 年至 2014 年，南部（2.4%-3.0%）和中西部（1.6%-2.4%）的 SA-IHCA 发生率增加。所有地区的死亡率均未显著增加或降低。与西部相比，东北部、中西部和南部的幸存者出院回家的可能性较小，更有可能转移到其他医疗机构。在 SA-IHCA 队列中，SA-IHCA 的平均住院时间在东北部最高（˜10.9 天），在中西部最低（˜8.6 天）（p<0.001）。西部的住院费用最高（234278 美元），中西部最低（125725 美元）（p<0.001）。
这项全国性分析表明，SA-IHCA 的发生率最高的是美国南部地区，而西部的院内死亡率最高。2007 年至 2014 年，中西部和南部的 SA-IHCA 发生率呈上升趋势。尽管脓毒症和 IHCA 的治疗取得了重大进展，但从 2007 年到 2014 年，美国任何地理区域的 SA-IHCA 发生率和随后的生存率均无显著改善。
