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Sepsis leading cause of early readmissions in the U.S.

By Will Boggs MD

January 27, 2017

NEW YORK (Reuters Health) – Unplanned 30-day readmissions are common after sepsis hospitalizations, according to data from the Nationwide Readmissions Database.


"The most interesting finding is that sepsis is the leading cause of 30-day readmissions in the U.S.,” Dr. Sachin Yende from VA Pittsburgh Healthcare System in Pennsylvania told Reuters Health by email. “Furthermore, readmissions following sepsis also cost more compared to readmissions following heart failure, heart attack, COPD, and pneumonia. Thus, sepsis accounts for a significant proportion of costs of readmissions.”

宾夕法尼亚州退伍军人匹兹堡医疗系统的Sachin Yende医生通过电子邮件对路透社健康频道说到:“最有趣的发现是,在美国,全身性感染是30天内再次入院的首要原因。而且,全身性感染后再次入院较心衰、心脏病、COPD及肺炎后再次入院的医疗费用更高。因此,全身性感染占再次入院医疗费用的相当比例。”

As part of its pay-for-performance program, the Centers for Medicare & Medicaid Services tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, COPD, and pneumonia, but not sepsis. The proportion and cost of unplanned readmissions following sepsis hospitalization were unknown until now.


To investigate, Dr. Yende and colleagues used data from the 2013 Nationwide Readmissions Database.


Sepsis accounted for 12.2% of the more than 1.1 million unplanned 30-day readmissions, far more than readmissions after hospitalizations for AMI (1.3%), heart failure (6.7%), COPD (4.6%), or pneumonia (5.0%).

在全国30天内非计划再次入院的超过1100万例患者中,全身性感染占12.2%,远远超过因AMI (1.3%)、心衰(6.7%)、COPD (4.6%)或肺炎(5.0%)住院后再次入院的比例。

Sepsis patients commonly had additional diagnoses, including AMI (0.7%), heart failure (3.4%), COPD (3.3%), and pneumonia (7.5%), the researchers report in JAMA, online January 22.

1月22日,研究者在JAMA在线发表报告显示,全身性感染患者通常具有其他诊断,包括AMI (0.7%),心衰(3.4%),COPD (3.3%) 和肺炎(7.5%)。

Durations of unplanned readmissions were longer following sepsis hospitalization than readmissions following AMI, heart failure, COPD, and pneumonia, and the estimated mean cost per readmission was significantly higher for sepsis ($10,070) than for AMI ($9424), heart failure ($9051), COPD ($8417), or pneumonia ($9533).

与AMI、心衰、COPD和肺炎后再次入院相比,全身性感染住院后非计划再次入院时间更长,全身性感染再次入院的平均费用($10,070)也显著高于AMI ($9424)、心衰($9051)、COPD ($8417) 或肺炎 ($9533)。

“There are recent studies showing that since the hospital readmission reduction program (HRRP) started, readmissions for heart failure, COPD, pneumonia, and heart attack have decreased,” Dr. Yende said.


“Whether adding sepsis readmissions to HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions (e.g., infections) and that most patients would prefer to avoid admission to the hospital,” he said.


“Although sepsis is an acute condition, it has long-term sequelae that last long after hospital discharge,” he concluded. “Thus, providers should consider developing programs/interventions to reduce these sequelae.”


Dr. Hallie Prescott from the University of Michigan Health System and VA Ann Arbor Healthcare System told Reuters Health by email, “We also know that a high proportion of these readmissions after sepsis are potentially preventable - suggesting that there may be an opportunity for improvement.”

密执根大学医疗中心及VA Ann Arbor医疗中心的Hallie Prescott医生在电子邮件中告诉路透社健康频道:“我们还知道,全身性感染后再次入院患者中大部分其实是可以预防的—提示可能存在很多继续改进的空间。”

“When treating sepsis survivors in clinic after hospitalization, we should focus our attention to common, treatable conditions that account for many of these readmissions - such as recurrent infection, heart failure exacerbation, renal failure, and aspiration,” said Dr. Prescott, an expert in pulmonary and critical care, who was not involved in the study.


Dr. Faheem Guirgis, an emergency physician at the University of Florida's UF Health Jacksonville, said, “Sepsis is a big problem, and one of the most difficult and common conditions faced by healthcare providers and policy makers. Contributing to the challenge is the lack of gold-standard diagnostic tests for making the diagnosis, changing definitions, and the complexity of taking care of septic patients.”

Faheem Guirgis医生是佛罗里达大学Jacksonville健康中心的急诊科医生,他说到:“全身性感染是个大问题,也是医务人员及政策制定者所面临的最为困难的常见问题。造成这一挑战的原因包括诊断缺乏金标准,定义在不断改变,以及全身性感染患者诊治过程的复杂性。”

"Furthermore, as the population grows older, and as the chronic disease burden of the general population increases, patients become more susceptible to sepsis,” he told Reuters Health by email. “Elderly patients, patients on hemodialysis and chemotherapy, the more times they access a healthcare facility the higher their risk of infection, and thus the higher their risk of sepsis. It's almost a consequence of advanced care that allows people to live longer with more medical conditions."


"I think prevention is one key, but there are going to be many other pieces to this puzzle," said Dr. Guirgis, who also was not involved study.


"Sepsis should not be viewed as a one-and-done phenomenon," said Dr. Mark E. Mikkelsen, chief of medical critical care at Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

“不应将全身性感染视为一劳永逸的疾病,”身为费城宾夕法尼亚大学Perelman医学院内科ICU主任的Mark E. Mikkelsen医生谈到。

"As many as one in four sepsis survivors are readmitted within 30 days, many with a recurrent life-threatening infection," he told Reuters Health by email. "Arming patients with this knowledge is key, so that patients and clinicians can detect and treat new or recurrent infections in a timely manner after sepsis."


"This study supports that the hospital readmission reduction program should add sepsis to their targeted conditions," said Dr. Mikkelsen, who was not part of the research.


SOURCE: http://bit.ly/2kiwjtn

JAMA 2017.


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