The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions
Abstract
Background: Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown. Objectives: Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death. Research Design: Retrospective cohort study. Subjects: A total of 17,716 30-day readmissions in an academic health system. Measures: We used mixed-effects multivariable logistic regression models to identify risk factors associated with the primary outcome, in-hospital death, or transition to hospice during 30-day readmissions. Results: Of 17,716 30-day readmissions, 1144 readmissions resulted in death or transition to hospice care (6.5%). Risk factors identified included: age, burden, and type of comorbid conditions, recent hospitalizations, nonelective index admission type, outside hospital transfer, low discharge hemoglobin, low discharge sodium, high discharge red blood cell distribution width, and disposition to a setting other than home. Sepsis (OR=1.33; 95% CI, 1.02–1.72; P=0.03) and shock (OR=1.78; 95% CI, 1.22–2.58; P=0.002) during the index admission were associated with the primary outcome, and in-hospital mortality specifically. In patients who died, infection was the primary cause for readmission in 51.6% of readmissions after sepsis and 28.6% of readmissions after a nonsepsis hospitalization (P=0.009). Conclusions: We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.
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Of the participants in the new RCT, 1,504 (62%) had sepsis.
“Of those participants, 1,504 (62%) had sepsis.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [531]
The literature search identified one new RCT of early enteral nutrition.
“The literature search identified one new RCT (531).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [531]
Sepsis 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 [622]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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- Authors
- Dietz, B. W., Jones, T. K., Small, D. S., Gaieski, D. F., & Mikkelsen, M. E.
- Affiliations
- University of Pennsylvania (US)
- Hospital of the University of Pennsylvania (US)
- Leonard Davis Institute of Health Economics (US)
- Thomas Jefferson University Hospital (US)
- Corresponding author
- Dietz, Brett W.
- Venue
- Medical Care
- Published
- 2017-04
- Volume
- 55
- Issue
- 4
- Pages
- 362-370
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2546794853
- Cited by
- 18
- References
- 48
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 7 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 1
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Nursing Research (R01NR016014)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- hospital readmission, 30-day readmission, in-hospital mortality, hospice care, sepsis, shock, infection, risk factors, comorbidities, red cell distribution width, hospital transfer, quality of care
- MeSH terms
- Aged, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Patient Readmission, Pennsylvania, Retrospective Studies, Risk Factors, Comorbidity, Hospice Care, Hospital Mortality, Sepsis
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