Readmission Diagnoses After Hospitalization for Severe Sepsis and Other Acute Medical Conditions

Readmission Diagnoses After Hospitalization for Severe Sepsis and Other Acute Medical ConditionsPatients are frequently rehospitalized within 90 days after having severe sepsis. 1 Little is known, however, about the reasons for readmission and whether they can be reduced.We sought to determine the most common readmission diagnoses after hospitalization for severe sepsis, the extent to which readmissions may be potentially preventable by posthospitalization ambulatory care, and whether the pattern of readmission diagnoses differs compared with that of other acute medical conditions.Methods | We studied participants in the nationally representative US Health and Retirement Study, 2 a multistage probability sample of households with adults aged 50 years or older, that is linked to Medicare claims (1998-2010).We identified hospitalizations with severe sepsis using a validated approach that requires International Classification of Diseases, Ninth Revision, Clinical Modification codes for both infection and acute organ dysfunction. 3,4We matched hospitalizations for severe sepsis to hospitalizations for 15 common acute medical conditions (Table ) 1:1 by age, sex, postdischarge comorbidity burden (Charlson Comorbidity Index), prehospitalization functional disability (limitations of activities and instrumental activities of daily living), and length of hospitalization using coarsened exact matching. 5 We measured the rate and 95% confidence interval of 90-day readmissions.Using the Healthcare Cost and Utilization Project's Clinical Classification Software, we determined the most common readmission diagnoses.To gauge what proportion of rehospitalizations may be potentially preventable, we measured ambulatory care sensitive conditions (AC-SCs), which are diagnoses for which effective outpatient care may reduce hospitalization rates. 6 We used ACSCs identified by the Agency for Healthcare Research and Quality, 6 and an expanded definition also including sepsis, skin or soft tissue infection, acute renal failure, and aspiration pneumonitis, all of which could plausibly be prevented or treated early to avoid rehospitalization.We compared readmission rates using McNemar χ 2 tests with significance at P < .001(2-sided) given multiple comparisons.The University of Michigan institutional review board approved this study; patients provided oral informed consent at enrollment and for Medicare linkage.complication of a device, implant, or graft, chest pain, fluid or electrolyte disorder, urinary tract infection, hip fracture, gastrointestinal hemorrhage, complication of surgical or medical care, syncope, and diabetes with complication.c Calculated using McNemar χ 2 tests.