Re-hospitalization 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 post-sepsis 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 versus ≥ 65 years), 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 ICD-9-CM codes for sepsis and separately for severe sepsis and septic shock.
MEASUREMENTS AND MAIN RESULTS:
The primary outcomes were rate of 90-day all-cause hospital readmission following sepsis hospitalization, and proportion of readmissions due to specific diagnoses, including the proportion of “potentially preventable” readmissions. Readmission diagnoses were similar from 2009-2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, chronic obstructive pulmonary disease) accounted for 30% of all readmissions. While about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounting for a greater proportion of readmissions among patients discharged to nursing facilities compared to patients discharged to home (25.0%-27.1% versus 16.8%) and in older versus younger patents (22.2% versus 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common more 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.