Readmissions after sepsis hospitalization are common, costly and occur early after discharge, according to new research published in the journal CHEST and the estimated annual cost of sepsis readmissions is greater than $3.5 billion, which the researchers say accounts for a significant under-recognized burden on the U.S. healthcare system when compared to $7.0 billion for the four conditions AMI, CHF, COPD and pneumonia. Sepsis patients are at the highest risk for readmission during the first week after discharge with a 17.5 percent rate of 30-day readmissions for all patients with sepsis.
The researchers noted other studies indicating more than 50% of the infection-related sepsis readmissions may be due to recurrent or unresolved infection-making antibiotic stewardship both during and after a sepsis hospitalization an important part of patient care. “An active surveillance for new or recurrent infections, ensuring removal/ discontinuation of indwelling catheters (which can be potential nidus for infections) with a strong push towards completion of therapy and follow-up with appropriate specialists might be important variables to be addressed at the time of discharge for these patients,” the authors stated.
Other factors are also at play.
Sepsis readmission was associated with a lower socioeconomic status or having Medicare/Medicaid as the primary payer, which may be related to the variation in access to care, chronic disease management skills, social support and health literacy in these patients, suggest the study authors. Old age and elderly patients with severe sepsis was also correlated with a lower readmission rate compared to the others in the study, who were 65 years or younger. The researchers stated that “It is likely that greater utilization of hospice and palliative services in the critically ill older population may be associated with decreased risk for readmission.” Also, as in previous research, the presence of malignancy was associated with a 30% to 50% increase in the risk of readmission, underscoring a need for targeted discussions and timely access to palliative care and hospice services in patients with active malignancies presenting with sepsis.
The researchers also observed that a longer length of stay (LOS) during the index admission was associated with greater odds of 30-day readmission, which is comparable to previous studies which indicate that prolonged hospital stays likely expose patients to nosocomial infections, in-hospital complications and further deconditioning, ultimately contributing to higher readmission risk. More than 40% of the readmissions were due to infectious causes. Further research is required to determine if the increased rate of infection after sepsis hospitalization, is attributable to the immunosuppressive effects of sepsis versus related to hospital interventions such as instrumentation, antibiotic and catheter use; or microbiome disruption during index admission.
Sepsis survivors are at risk for readmissions from pulmonary complications, cardiovascular events, including exacerbation of heart failure and acute renal failure. Pointing to earlier research, the authors said patients who were recently hospitalized are not only recovering from their acute illness, but they also experience a transient period of generalized risk for a wide range of adverse health events. Polypharmacy, nutritional deficits, disturbances in circadian rhythm and deconditioning could be some of the factors contributing to this state. Post-acute care is another important target for intervention to reduce sepsis readmissions as the analysis showed nearly 40% of patients who had a readmission were discharged to a facility at the time of the index admission. Moreover, discharge to a facility was associated with increased 30-day readmission. Hence, collaborative efforts with post-acute care providers is critical to reducing readmissions.
