Variation in Postsepsis Readmission Patterns: A Cohort Study ofVeterans Affairs Beneficiaries

摘要

>Rationale: Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations.>Objectives: To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries.>Methods: Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009–2011) at 114 VA hospitals, stratified by age (<65 vs. ≥65 yr), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital. In the primary analysis, sepsis hospitalizations were identified using a previously validated method. Sensitivity analyses were performed using alternative definitions with explicit International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sepsis, and separately for severe sepsis and septic shock.>Measurements and Main Results: The primary outcomes were rate of 90-day all-cause hospital readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of “potentially preventable” readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmissionrates across hospitals. The top six readmission diagnoses (heart failure,pneumonia, sepsis, urinary tract infection, acute renal failure, and chronicobstructive pulmonary disease) accounted for 30% of all readmissions. Althoughabout one in five readmissions had a principal diagnosis for infection, 58% ofall readmissions received early systemic antibiotics. Infection accounted for agreater proportion of readmissions among patients discharged to nursingfacilities compared with patients discharged to home (25.0–27.1% vs.16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentiallypreventable readmissions accounted for a quarter of readmissions overall andwere more common among older patients and patients discharged to nursingfacilities.>Conclusions: Hospital readmission rates after sepsis were similar bysite and admission year. Heart failure, pneumonia, sepsis, and urinary tractinfection were common readmission diagnoses across all patient groups.Readmission for infection and potentially preventable diagnoses were more commonin older patients and patients discharged to nursing facilities.