Cost of sepsis readmissions exceeds $16,000 per patient

By Christopher Cheney, HealthLeaders Media 

The annual estimated cost of sepsis readmissions is about half the annual cost of all four of the conditions in Medicare's Hospital Readmissions Reduction Program, recent research shows.

"In our study, the estimated annual cost of sepsis readmissions amounted to more than $3.5 billion within the United States. When compared to $7.0 billion for the four conditions (AMI, CHF, COPD and pneumonia) targeted by the Hospital Readmissions Reduction Program (HRRP), this accounts for a significant under-recognized burden on the U.S. healthcare system," the researchers wrote in the journal CHEST.

Sepsis is the body's extreme reaction to an infection, which can result in life-threatening symptoms such as multiple organ failure. Annually, more than 1.5 million people get sepsis in the United States, with about 250,000 fatalities.

The economic impact of sepsis on a national scale is significant, the CHEST researchers found in their study, which featured more than 1 million index admissions.

• The annual cost of index admissions for sepsis was estimated at more than $23.3 billion
• The mean cost per sepsis readmission within 30 days of discharge was $16,852
• 30-day readmissions after an index admission for sepsis accounted for 13% of all sepsis-related hospitalization costs

The lead author of the CHEST research, Shruti Gadre, MD, told HealthLeadersthat sepsis readmissions are likely expensive because of intensive care unit treatment, antibiotics administration, and invasive procedures.

Sepsis readmissions are expensive relative to the HRRP conditions most likely because of the acuity of sepsis patients, said Gadre, a member of the Department of Pulmonary, Allergy and Critical Care Medicine at Cleveland Clinic's Respiratory Institute.

"The hypothesis is that sepsis patients are sicker when they get readmitted to the hospital. They require ICU-level care and may have multi-organ involvement compared with patients with AMI, heart failure, COPD, and pneumonia, which may lead to higher costs."

Anticipating readmissions

For patients who had an index sepsis admission, 17.5% were readmitted within 30 days. Gadre and her research team identified predictors of sepsis readmissions.

• Infection was the most common cause for 30-day readmissions, accounting for 42.16% readmitted patients.
• Sepsis accounted for 22.86% of readmissions.

 The other most common causes for sepsis readmissions were gastrointestinal (9.60%), cardiovascular (8.73%), pulmonary (7.82%), and renal (4.99%) conditions.

"Our findings serve to create awareness among clinicians, administrators and policy makers alike regarding patient populations that are vulnerable to sepsis readmission and thus increased utilization of resources. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome," the research team wrote.