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Medline ® Abstract for Reference 71

of 'Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis'

71
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Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007.
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Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK
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Crit Care Med. 2012;40(3):754.
 
OBJECTIVES: To assess trends in number of hospitalizations, outcomes, and costs of severe sepsis in the United States.
DESIGN: Temporal trends study using the Nationwide Inpatient Sample.
PATIENTS: Adult patients with severe sepsis (defined as a diagnosis of sepsis and organ dysfunction) diagnosed between 2003 and 2007.
MEASUREMENTS AND MAIN RESULTS: We determined the weighted frequency of patients hospitalized with severe sepsis. We calculated age- and sex-adjusted population-based mortality rates for severe sepsis per 100,000 population and also used logistic regression to adjust in-hospital mortality rates for patient characteristics. We calculated inflation-adjusted costs using hospital-specific cost-to-charge ratios. We identified a rapid steady increase in the number of cases of severe sepsis, from 415,280 in 2003 to 711,736 in 2007 (a 71% increase). The total hospital costs for all patients with severe sepsis increased from $15.4 billion in 2003 to $24.3 billion in 2007 (57% increase). Theproportion of patients with severe sepsis and only a single organ dysfunction decreased from 51% in 2003 to 45% in 2007 (p<.001), whereas the proportion of patients with three or four or more organ dysfunctions increased 1.19-fold and 1.51-fold, respectively (p<.001). During the same time period, we observed 2% decrease per year in hospital mortality for patients with severe sepsis (p<.001), as well as a slight decrease in the length of stay (9.9 days to 9.2 days; p<.001) and a significant decrease in the geometric mean cost per case of severe sepsis ($20,210 per case in 2003 and $19,330 in 2007; p = .025).
CONCLUSIONS: The increase in the number of hospitalizations for severe sepsis coupled with declining in-hospital mortality and declining geometric mean cost per case may reflect improvements in care or increases in discharges to skilled nursing facilities; however, these findings more likely represent changes in documentation and hospital coding practices that could bias efforts to conduct national surveillance.
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Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA. lagutc@gmail.com
PMID