Almost 42% of patients who survived severe sepsis and were rehospitalized within 90 days had conditions for which appropriate outpatient care can potentially prevent readmissions, investigators wrote online March 10 in a letter to JAMA.

These “ambulatory care sensitive conditions” (or ACSCs) accounted for significantly more readmissions among sepsis survivors, compared with patients whose initial hospitalizations were for other reasons, said Dr. Hallie Prescott of the University of Michigan, Ann Arbor, and her associates.

The findings support exploring “the feasibility and potential benefit of post-discharge interventions that are tailored to patients’ personalized risk for a limited number of common conditions,” the investigators said (JAMA 2015;313:1055-7).Patients who survive severe sepsis are often rehospitalized soon afterward, but fairly little is known about the reasons for rehospitalization or whether better outpatient care might prevent some of these readmissions, the researchers said. To explore these questions, they used the Medicare-linked U.S. Health and Retirement Study to study hospitalization codes that indicated sepsis – that is, both acute infection and organ dysfunction. They also compared survivors of severe sepsis with patients who were discharged after hospitalization for 15 other common conditions.

Severe sepsis did not seem to increase the likelihood of rehospitalization – about 42% of both groups of patients were readmitted within 90 days, Dr. Prescott and her associates said. However, ACSCs such as heart failure, pneumonia, worsening chronic obstructive pulmonary disease, and urinary tract infections accounted for about 42% of 90-day readmissions among sepsis survivors (95% confidence interval, 39.2% to 44.1%), versus 37% of the comparison group (95% confidence interval, 34.8%-39.5%; P = .009).

Further, survivors of severe sepsis (12%; 95% confidence interval, 10.6%-13.1%) were more likely than other patients (8%; 95% CI, 7.0%-9.1%; P < .001) to be readmitted with another primary infection, including sepsis, pneumonia, urinary tract infections, and skin and soft tissue infections.

“A limitation of the present study is that we inferred the potential preventability of re-hospitalizations by measuring readmissions for ACSCs,” the researchers noted. “Whether these diagnoses represent preventable admissions, especially after sepsis, is not clear.”

The National Institutes of Health and the Department of Veterans Affairs Health Services Research & Development Service funded the study. The authors reported having no relevant conflicts of interest.


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