Priscilla Hartley is an assistant professor, College of Nursing, Augusta University, Athens, Georgia.
Jordan Pelkmans is a biostatistician, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Am J Crit Care. 2024 Sep 1;33(5):353-363. doi: 10.4037/ajcc2024947.
Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors.
To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged.
The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings.
From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings.
Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.
脓毒症是一种发病率和死亡率都很高的复杂病症。及时治疗可以提高存活率，但对于幸存者而言，病情恶化和再次入院的风险仍然很高。关于出院地点与脓毒症幸存者再入院之间的关系，人们知之甚少。
根据患者出院地点的类型，调查成年脓毒症幸存者的 30 天医院再入院率。
使用医疗信息集市重症监护数据库（Medical Information Mart for Intensive Care database）确定成年脓毒症幸存者，并根据出院地点评估 30 天再入院情况。使用 χ2 连续性校正分析每个因素与再入院的关系。使用 Kruskal-Wallis 检验比较不同出院地点的再入院情况。
在我们的样本（N = 7107；平均年龄 66.5 岁；46.2%为女性）中，23.6%（n = 1674）在 30 天内再次入院，其中 30%在 1 至 3 次之间再次入院。出院地点（P <.001）和年龄（P =.02）与再入院显著相关，但性别、种族和保险类型与再入院无关。出院至疗养院（29.6%）、家庭保健（26.9%）和家庭（15.0%）的患者再入院人数较多。这些出院地点的患者同样存在较高的合并症负担和疾病严重程度。
出院至疗养院、家庭保健和家庭的脓毒症幸存者在 30 天内再次入院的风险较高。出院至家庭保健和家庭的患者再入院率令人震惊。通常患者出院至不合适的地点，使他们面临残余脓毒症和再次入院的风险。未来的研究应侧重于医院出院的适当时机和向最合适的出院地点的过渡。
