FROM CRITICAL CARE MEDICINE

Sepsis-related hospital readmission costs in California adults were more than double those for congestive heart failure (CHF) and more than triple those for acute myocardial infarction (AMI) between 2009 and 2011, a retrospective cohort analysis showed.

The all-cause, 30-day readmission rates among 240,198 sepsis patients, 193,153 CHF patients, and 105,684 AMI patients were 20.4%, 23.6%, and 17.7%, respectively, and the estimated annual costs of those readmissions were $500 million, $229 million, and $142 million, respectively, Dr. Dong W. Chang of Harbor-UCLA Medical Center, Torrance, Calif. and colleagues reported online in Critical Care Medicine (June 30, 2015 [doi:10.1097/CCM.0000000000001159] ).

Patient-level factors associated with greater likelihood of 30-day readmission after sepsis included younger age (odds ratio, 1.34 for youngest vs. oldest age categories), black race (odds ratio, 1.29 vs. white race), Native American race (odds ratio, 2.39 vs. white race), and lower income (odds ratio, 1.13 for lowest vs. highest income quartiles). Male gender, residence in metropolitan areas, and greater burden of medical comorbidities were also associated with readmission after sepsis.

Hospital-level factors associated with greater likelihood of readmission included health care delivery to the highest vs. lowest quintile of minorities (odds ratio, 1.28), for-profit status (odds ratio, 1.34), and university vs. nonuniversity hospital setting (odds ratio, 1.35), the investigators found.

The findings, derived from the Healthcare Cost and Utilization Project State Inpatient Database maintained by the Agency for Healthcare Research and Quality, show that sepsis is a leading contributor to excess health care costs related to hospital readmissions.

A better understanding of the causative events leading to sepsis readmissions is needed, the investigators noted, and if studies and policies seeking to reduce hospital readmissions are to be effective, they will need to focus on the problem of sepsis-related readmissions – on a level that is at least comparable to CHF and AMI.

Dr. Chang received research support from the National Institutes of Health.

sworcester@frontlinemedcom.com

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