Proportion and Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical Conditions

Proportion and Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical Conditions The Centers for Medicare & Medicaid Services (CMS) uses 30-day readmission rates to measure quality of care and guide pay-for-performance. The CMS tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia because hospitalizations for these conditions are frequent and account for a large proportion of readmissions.1 The proportion and cost of unplanned readmissions following sepsis hospitalizations are not known. We hypothesized that sepsis hospitalizations account for a higher proportion of unplanned 30-day readmissions than hospitalizations for AMI, heart failure, COPD, and pneumonia in the United States. Methods | We analyzed data from the 2013 Nationwide Readmissions Database, which aggregates acute care hospitalizations from 21 states and represents inpatient use for 49% of the US population.2 This study was deemed exempt by the University of Pittsburgh institutional review board. For adults aged 18 years or older, we identified index admissions for medical reasons (using diagnosis-related group codes) that were followed by an unplanned hospital readmission within 30 days of discharge. We excluded index admissions if patients were not discharged alive, left against medical advice, were transferred to another acute care hospital, or occurred during December (because data for 30-day readmissions were not available). Patients with more than 1 admission-readmission episode could be included. For these patients, we determined the weighted proportions of index admissions due to sepsis, AMI, COPD, heart failure, and pneumonia. Because patients hospitalized for AMI, heart failure, COPD, and pneumonia may have sepsis,