Kelly Farrah1,2,3,4,5,6, Lauralyn McIntyre1,2,4, Christopher J Doig5, Robert Talarico3, Monica Taljaard1,2, Murray Krahn6, Dean Fergusson1,2, Alan J Forster2,3, Doug Coyle1, Kednapa Thavorn1,2,3,4,5,6. 1. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 2. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada. 3. ICES uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada. 4. Division of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. 5. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 6. Toronto Health Economics and Technology Assessment Collaborative, Toronto General Research Institute, Toronto, ON, Canada.
Abstract
OBJECTIVES: To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls. DESIGN: Propensity-matched population-based cohort study using administrative data. SETTING: Ontario, Canada. PATIENTS: We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsis patients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsis patients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63-1.68). Both severe and nonsevere sepsis patients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50-1.55 and hazard ratio, 1.41; 95% CI, 1.40-1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568-$29,913) for severe and $9,475 (95% CI, $9,150-$9,727) for nonsevere sepsis. CONCLUSIONS: Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.
OBJECTIVES: To examine long-term mortality, resource utilization, and healthcare costs in sepsispatients compared to hospitalized nonsepsis controls. DESIGN: Propensity-matched population-based cohort study using administrative data. SETTING: Ontario, Canada. PATIENTS: We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsispatients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsispatients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63-1.68). Both severe and nonsevere sepsispatients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50-1.55 and hazard ratio, 1.41; 95% CI, 1.40-1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568-$29,913) for severe and $9,475 (95% CI, $9,150-$9,727) for nonsevere sepsis. CONCLUSIONS: Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.
Authors: Federico Angriman; Laura C Rosella; Patrick R Lawler; Dennis T Ko; Hannah Wunsch; Damon C Scales Journal: Intensive Care Med Date: 2022-02-10 Impact factor: 41.787
Authors: Konrad F R Schmidt; Katharina Huelle; Thomas Reinhold; Hallie C Prescott; Rebekka Gehringer; Michael Hartmann; Thomas Lehmann; Friederike Mueller; Konrad Reinhart; Nico Schneider; Maya J Schroevers; Robert P Kosilek; Horst C Vollmar; Christoph Heintze; Jochen S Gensichen Journal: J Clin Med Date: 2022-02-21 Impact factor: 4.241