Sepsis Leading Cause of Hospital Readmission and Associated Costs

Sepsis is a leading cause of hospital readmissions and associated costs, surpassing other frequent hospital readmission conditions such as acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. The findings were published in a research letter in the Journal of the American Medical Association.

Florian B. Mayr, MD, MPH, from the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System in Pennsylvania, and colleagues analyzed data from the 2013 Nationwide Readmissions Database, which is comprised of acute care hospitalizations from 21 states, corresponding to inpatient use in 49% of the US population.

Primary analyses were done using International Classification of Diseases, Ninth Revision, Clinical Modification codes in “10 discharge diagnoses fields to identify sepsis.” Dr Mayr and colleagues used the Centers for Medicare & Medicaid Services (CMS) methods, which use only the primary discharge diagnosis field, to identify the remaining 4 conditions: AMI, heart failure, COPD, and pneumonia. Sensitivity analyses were conducted “using stringent criteria used by CMS for sepsis and extended the CMS criteria to identify the remaining 4 conditions to 10 discharge diagnoses fields.”

Researchers identified 1,1187,697 index admissions for medical reasons (using diagnosis-related group codes) that were associated with an unplanned 30-day readmission. The data for diagnoses of sepsis, AMI, heart failure, COPD, and pneumonia are shown in Table 1.

Table 1. Index Admissions Readmitted Within 30 Days

Medical Condition	n (%)	95% CI (%)
Sepsis	147,084 (12.2)	11.9 – 12.4
AMI	15,001 (1.3)	1.2 – 1.3
Heart Failure	79,480 (6.7)	6.5 -6.8
COPD	54, 396 (4.6)	4.5 – 4.8
Pneumonia	59 378 (5.0)	5.0 – 5.3

AMI = acute myocardial infarction; COPD = chronic obstructive pulmonary disease

Among sepsis index admissions, 0.7% met the criteria for AMI, 3.4% for heart failure, 3.3% for COPD, and 7.5% for pneumonia.

Sepsis had a mean length of hospital stay longer than AMI, heart failure, COPD, and pneumonia. In a similar manner, the estimated mean cost per admission was highest in sepsis compared with the 4 other medical diagnoses (see Table 2). In sensitivity analyses, sepsis remained the leading cause of readmission and cost.

Table 2: Estimated Mean Cost per Readmission*

Medical Condition	Cost (95% CI), $
Sepsis	10,070 (10,021 – 10,119)
AMI	9424 (9279 – 9571)
Heart Failure	9051 (8990 – 9113)
COPD	9533 (9466 – 9600)
Pneumonia	8417 (8355 – 8480)

* P <.005 for all pairwise comparisons.
AMI = acute myocardial infarction; COPD = chronic obstructive pulmonary disease

“Adding sepsis to the Hospital Readmission Reduction Program may lead to development of new interventions to reduce unplanned readmissions and associated costs,” Dr Mayr and colleagues concluded.

Reference

Mayr FB, Talisa VB, Balakumar V, Chang CH, Fine M, Yende S. Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions [published online January 22, 2017]. JAMA. doi:10.1001/jama.2016.20468