Population Burden of Long‐Term Survivorship After Severe Sepsis in Older Americans

Abstract

Objectives: To ascertain the absolute number of M edicare beneficiaries surviving at least 3 years after severe sepsis and to estimate their burden of cognitive dysfunction and disability. Design: Retrospective cohort analysis of M edicare data. Setting: All short‐stay inpatient hospitals in the U nited S tates, 1996 to 2008. Participants: Individuals aged 65 and older. Measurements: Severe sepsis was detected using a standard administrative definition. Case‐fatality, prevalence, and incidence rates were calculated. Results: Six hundred thirty‐seven thousand eight hundred sixty‐seven M edicare beneficiaries were alive at the end of 2008 who had survived severe sepsis 3 or more years earlier. An estimated 476,862 (95% confidence interval ( CI ) = 455,026–498,698) had functional disability, with 106,311 (95% CI = 79,692–133,930) survivors having moderate to severe cognitive impairment. The annual number of new 3‐year survivors after severe sepsis rose 119% during 1998 to 2008. The increase in survivorship resulted from more new diagnoses of severe sepsis rather than a change in case‐fatality rates; severe sepsis rates rose from 13.0 per 1,000 M edicare beneficiary‐years to 25.8 ( P < .001), whereas 3‐year case fatality rates changed much less, from 73.5% to 71.3% ( P < .001) for the same cohort. Increasing rates of organ dysfunction in hospitalized individuals drove the increase in severe sepsis incidence, with an additional small contribution from population aging. Conclusions: Sepsis survivorship, which has substantial long‐term morbidity, is a common and rapidly growing public health problem for older A mericans. There has been little change in long‐term case‐fatality, despite changes in practice. Clinicians should anticipate more‐frequent sequelae of severe sepsis in their patient populations.