The impact of age on sepsis revisits and readmissions
Wardi G, Joel I, Tolia VM, Castillo EM, Tainter C, Hsia RY, Brennan JJ, and Jayaprakash N. The impact of age on sepsis revisits and readmissions. Acad Emerg Med 2019; 26:S45.
Acad Emerg Med
Background: Little is known on the relationship between age and re-visits to the ED after an admission for sepsis. The purpose of this study was to quantify the impact of age on re-visits to the ED after an admission for sepsis and describe outcomes of these patients. Methods: Multi-center retrospective longitudinal cohort study using data from the Office of Statewide Health Planning and Development (OSHPD) database to identify all patients (age ≥ 18 years) with sepsis-related admissions and ED encounters in California between 2008 and 2015. We limited our search to the initial (“index”) admission and included patients with a diagnosis of sepsis, severe sepsis or septic shock. Age groups were 18 - 44, 45 - 64, 65 - 74, 75 - 84, and 85+. ED re-visit and readmission periods were divided into the following time periods after hospital discharge: < 7 days, within 30 days, within 6 months, and within 1 year. Mortality rates during similar time periods was also included, but were limited here to patients who returned to and expired within an ED or hospital within the specified time period. Data were analyzed in SPSS version 25 and descriptive statistics were reported as indicated. Results: We identified 675,391 index hospital admissions of patients with sepsis. We found an overall 10.4% revisit rate to the ED within 7 days of hospital discharge, a 24.8% revisit rate at 30 days, a 45.7% revisit rate at 6 months and 50.1% revisit rate at 1 year. Readmission rate was 6.9% at 7 days, 17.9% at 30 days, 34.8% at 6 months and 39.2% at 1 year. ED revisit and readmission rates were similar in age groups of 45-64, 65-74, 75-84 and 85+ for sepsis but lower in age 18-44 at 1 year [OR of admission when compared to age 18 - 44: 1.46 (1.43, 1.48), 1.58 (1.55,1.61), 1.65 (1.62,1.68), 1.49 (1.46,1.52), respectively]. Mortality within 7 days, 30 days, 6 months and 1 year was: 0.7%, 2.4%, 6.5% and 8.2%, respectively. We found an escalating increase in mortality rate with each increase in age group as well as severity of sepsis during index admission. Conclusion: Patients with age > 44 admitted to the hospital with sepsis are at high risk for revisits to the ED and readmission in the year following an admission for sepsis. Mortality rates in these patients are strongly associated with increasing age and severity of sepsis. More research is needed into the impact of geriatric specific emergency care on sepsis in the older and higher risk age groups.