Readmission to a Different Hospital and Worse Outcomes Following Sepsis: A Nationwide Cohort Study

BackgroundIn the United States (U.S.), sepsis accounts for 13% of total hospital expenses and more than 50% of hospital deaths. People with sepsis are more likely to be readmitted. Little is known about the prevalence and outcomes of different hospital readmissions (DHR) in sepsis patients, and the factors associated with DHR have not been well studied.MethodsWe used data during 2010 to 2017 from the Nationwide Readmissions Database of the U.S. 2010 to 2017 to identify the patients with admission for sepsis. Multivariable logistic regression analysis was used to evaluate the associated factors for DHR, and five models were constructed to elucidate the relationship between DHR and in-hospital outcomes.Results From 2010 to 2017, 450,560 (19.65%) of all readmitted sepsis patients in the U.S. were readmitted to a different hospital within 30 days. The prevalence of DHR increased from 18.45% in 2010 to 22.07% in 2017 (P for trend < 0.001). The factors associated with DHR included elective admission, diabetes, drug abuse, alcohol abuse, psychoses, and depression. The most common reason for readmission was infections irrespective of hospital status. DHR was associated with higher hospitalization costs [$4,909, 95% confidence interval (CI), $4,542-$5,276, P<0.001], longer length of stay (LOS) (0.97 days, 95% CI, 0.87 days-1.08 days, P<0.001), and higher risk of in-hospital mortality (odds ratio,1.08, 95% CI, 1.04-1.12, P < 0.001).ConclusionsDHR occurred for one fifth of sepsis patients in the U.S. Our findings suggest that patients readmitted to a different hospital within 30 days may experience higher in-hospital mortality, longer LOS, and higher hospitalization costs. Future studies need to examine whether continuity of care can improve the prognosis of patients with sepsis.