Hospital-based acute care use in survivors of septic shock.
Open accessAbstract
OBJECTIVES: Septic shock is associated with increased long-term morbidity and mortality. However, little is known about the use of hospital-based acute care in survivors after hospital discharge. The objectives of the study were to examine the frequency, timing, causes, and risk factors associated with emergency department visits and hospital readmissions within 30 days of discharge. DESIGN: Retrospective cohort study. SETTING: Tertiary, academic hospital in the United States. PATIENTS: Patients admitted with septic shock (serum lactate≥4 mmol/L or refractory hypotension) and discharged alive to a nonhospice setting between 2007 and 2010. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The coprimary outcomes were all-cause hospital readmission and emergency department visits (treat-and-release encounters) within 30 days to any of the three health system hospitals. Of 269 at-risk survivors, 63 (23.4%; 95% CI, 18.2-28.5) were readmitted within 30 days of discharge and another 12 (4.5%; 95% CI, 2.3-7.7) returned to the emergency department for a treat-and-release visit. Readmissions occurred within 15 days of discharge in 75% of cases and were more likely in oncology patients (p=0.001) and patients with a longer hospital length of stay (p=0.04). Readmissions were frequently due to another life-threatening condition and resulted in death or discharge to hospice in 16% of cases. The reasons for readmission were deemed potentially related to the index septic shock hospitalization in 78% (49 of 63) of cases. The most common cause was infection related, accounting for 46% of all 30-day readmissions, followed by cardiovascular or thromboembolic events (18%). CONCLUSIONS: The use of hospital-based acute care appeared to be common in septic shock survivors. Encounters often led to readmission within 15 days of discharge, were frequently due to another acute condition, and appeared to result in substantial morbidity and mortality. Given the potential public health implications of these findings, validation studies are needed.
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Many sepsis survivors experience short and/or long-term sequelae such as cognitive and/or physical disability, with ongoing recovery persisting for months to years.
“Many sepsis survivors experience short and/or longterm sequela such as cognitive and/or physical disability, with ongoing recovery persisting for months to years (620).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [620]
The introductory passage following the Abstract > Conclusions says sepsis survivorship is associated with cognitive and physical impairments, and the Discussion describes possible functional impairments and a path to recovery. Neither passage establishes that recovery continues for months to years; this study focuses on hospital-based acute care after discharge. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSepsis is associated with newly acquired cognitive impairment and functional disability amongst survivors.
“Sepsis is associated with newly acquired cognitive impairment and functional disability amongst survivors (620).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [620]
The introductory passage (indexed under Abstract > Conclusions; page unavailable) states that sepsis survivorship is associated with cognitive and physical impairments. The Discussion mentions possible new or progressive functional impairments, but does not establish that the cognitive impairment and functional disability are newly acquired; it says that possibility requires direct examination. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSepsis survivors are at risk for hospital readmission, which has been associated with increased mortality or discharge to hospice.
“Sepsis survivors are at risk for hospital readmission, which has been associated with increased mortality or discharge to hospice [622, 623].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [623]
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Self-citation
- Authors
- Ortego, A., Gaieski, D. F., Fuchs, B. D., Jones, T., Halpern, S. D., Small, D. S., Sante, S. C., Drumheller, B., Christie, J. D., & Mikkelsen, M. E.
- Affiliations
- University of Pennsylvania (US)
- Geisinger College of Health Sciences (US)
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2015-04
- Volume
- 43
- Issue
- 4
- Pages
- 729-737
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC4359663
- OpenAlex
- W2312765923
- Semantic Scholar
- 654837f345a9ff2617f58da6c5df82d17117dd26
- Cited by
- 67
- References
- 53
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 11 · 2018: 6 · 2017: 11 · 2016: 5 · 2015: 12
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ScholarlyCommons (University of Pennsylvania) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (L30 HL115698)
- National Institute of General Medical Sciences (L30 GM086101)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- septic shock, 30-day readmission, emergency department visits, risk factors for readmission, length of hospital stay, cancer patients, mortality
- MeSH terms
- Emergency Service, Hospital, Female, Humans, Length of Stay, Male, Middle Aged, Patient Readmission, Retrospective Studies, Shock, Septic, United States, Cohort Studies
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