Sarah Elfeky1, Pegah Golabi2, Munkhzul Otgonsuren2, Svetolik Djurkovic1, Mary E Schmidt1, Zobair M Younossi3. 1. Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA. 2. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA. 3. Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA. Electronic address: Zobair.younossi@inova.org.
Abstract
PURPOSE: To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis. MATERIAL AND METHODS: This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. RESULTS: Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P<.001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality. CONCLUSION: Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.
PURPOSE: To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis. MATERIAL AND METHODS: This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. RESULTS: Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P<.001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality. CONCLUSION: Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.
Authors: Dara L Horn; Jolie Shen; Emma Roberts; Theresa N Wang; Kevin S Li; Grant E O'Keefe; Joseph Cuschieri; Eileen M Bulger; Bryce R H Robinson Journal: J Trauma Acute Care Surg Date: 2020-07 Impact factor: 3.697