Inpatient hospital performance is associated with post-discharge sepsis mortality.
Inpatient hospital performance is associated with post-discharge sepsis mortality.
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DOI：
10.1186/s13054-020-03341-3
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发表时间：
2020-10-27
期刊：
影响因子：
--
通讯作者：
Carr BG
中科院分区：
文献类型：
--
作者：
Mohr NM;Zebrowski AM;Gaieski DF;Buckler DG;Carr BG
出院后死亡在因败血症住院的患者中很常见，但出院后死亡的驱动因素尚不清楚。本研究的目的是检验这样一个假设，即具有高风险调整的住院脓毒症死亡率的医院也具有高的出院后死亡率、再入院率和出院到疗养院。2013年1月至2014年12月期间因败血症住院的符合年龄条件的医疗保险受益人的回顾性队列研究。出院后随访180天的住院幸存者，并测量死亡率、再入院率和新入院的专业护理机构。住院患者医院特定脓毒症风险调整的死亡率比（观察：预期）是主要暴露。队列中共有830，721例患者因败血症住院，住院死亡率为20%，90天死亡率为48%。较高的医院特异性脓毒症风险调整死亡率与出院后90天死亡率增加相关（住院患者O：E比每增加0.1，aOR 1.03，95% CI 1.03-1.04）。较高的住院风险调整死亡率也与出院到护理机构（aOR 1.03，95% CI 1.02-1.03）和90天再入院（aOR 1.03，95% CI 1.02-1.03）的概率增加相关。具有最高风险调整败血症住院死亡率的医院也具有较高的出院后死亡率和增加的再入院率，这表明出院后并发症是一种可改变的风险，可能会在住院治疗期间受到影响。未来的工作将寻求阐明住院和医疗实践，可以减少脓毒症出院后并发症。
Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure. A total of 830,721 patients in the cohort were hospitalized for sepsis, with inpatient mortality of 20% and 90-day mortality of 48%. Higher hospital-specific sepsis risk-adjusted mortality was associated with increased 90-day post-discharge mortality (aOR 1.03 per each 0.1 increase in hospital inpatient O:E ratio, 95% CI 1.03–1.04). Higher inpatient risk adjusted mortality was also associated with increased probability of being discharged to a nursing facility (aOR 1.03, 95% CI 1.02–1.03) and 90-day readmissions (aOR 1.03, 95% CI 1.02–1.03). Hospitals with the highest risk-adjusted sepsis inpatient mortality also have higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications are a modifiable risk that may be affected during inpatient care. Future work will seek to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
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影响因子：
3
作者：
Deb, Partha;Murtaugh, Christopher M.;Feldman, Penny H.
通讯作者：
Feldman, Penny H.
影响因子：
8.8
作者：
Hatfield KM;Dantes RB;Baggs J;Sapiano MRP;Fiore AE;Jernigan JA;Epstein L
通讯作者：
Epstein L
影响因子：
7.1
作者：
Brück E;Schandl A;Bottai M;Sackey P
通讯作者：
Sackey P
影响因子：
7.2
作者：
Davydow, Dimitry S.;Hough, Catherine L.;Iwashyna, Theodore J.
通讯作者：
Iwashyna, Theodore J.
影响因子：
4.3
作者：
Marra, Annachiara;Ely, E. Wesley;Patel, Mayur B.
通讯作者：
Patel, Mayur B.