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Resource Utilization Among Patients With Sepsis Syndrome

Published online by Cambridge University Press:  02 January 2015

David W. Bates*
Affiliation:
Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
D. Tony Yu
Affiliation:
Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Edgar Black
Affiliation:
Division of General Internal Medicine, Department of Medicine, University of Rochester School of Medicine, Rochester, New York
Kenneth E. Sands
Affiliation:
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
J. Sanford Schwartz
Affiliation:
Division of General Internal Medicine, Department of Medicine, and the Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
Patricia L. Hibberd
Affiliation:
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
Paul S. Graman
Affiliation:
Infectious Diseases Unit, Department of Medicine, University of Rochester School of Medicine, Rochester, New York
Paul N. Lanken
Affiliation:
Pulmonary and Critical Care Division, Department of Medicine, and the Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
Katherine L. Kahn
Affiliation:
Division of General Internal Medicine, University of California at Los Angeles Medical Center, Los Angeles, California
David R. Snydman
Affiliation:
Division of Infectious Diseases, Department of Medicine and Pathology, New England Medical Center andTufts University School of Medicine, Boston, Massachusetts
Jeffrey Parsonnet
Affiliation:
Infectious Disease Section, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Richard Moore
Affiliation:
Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
Richard Platt
Affiliation:
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts
*
Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115

Abstract

Objective:

To assess the resource utilization associated with sepsis syndrome in academic medical centers.

Design:

Prospective cohort study.

Setting:

Eight academic, tertiary-care centers.

Patients:

Stratified random sample of 1,028 adult admissions with sepsis syndrome and all 248,761 other adult admissions between January 1993 and April 1994. The main outcome measures were length of stay (LOS) in total and after onset of sepsis syndrome (post-onset LOS) and total hospital charges.

Results:

The mean LOS for patients with sepsis was 27.7 ± 0.9 days (median, 20 days), with sepsis onset occurring after a mean of 8.1 ± 0.4 days (median, 3 days). For all patients without sepsis, the LOS was 7.2 ± 0.03 days (median, 4 days). In multiple linear regression models, the mean for patients with sepsis syndrome was 18.2 days, which was 11.0 days longer than the mean for all other patients (P < .0001), whereas the mean difference in total charges was $43,000 (both P < .0001). These differences were greater for patients with nosocomial as compared with community-acquired sepsis, although the groups were similar after adjusting for pre-onset LOS. Eight independent correlates of increased post-onset LOS and 12 correlates of total charges were identified.

Conclusions:

These data quantify the resource utilization associated with sepsis syndrome, and demonstrate that resource utilization is high in this group. Additional investigation is required to determine how much of the excess post-onset LOS and charges are attributable to sepsis syndrome rather than the underlying medical conditions.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP. The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 1995;273:117123.CrossRefGoogle ScholarPubMed
2.Wenzel, RP. Anti-endotoxin monoclonal antibodies: a second look. N Engl J Med 1992;326:11511153.Google Scholar
3.Niederman, MS, Fein, AM. Sepsis syndrome, the adult respiratory distress syndrome, and nosocomial pneumonia: a common clinical sequence. Clin Chest Med 1990;11:633656.Google Scholar
4.Abraham, E, Wunderink, R, Silverman, H, et al. Efficacy and safety of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis syndrome: a randomized, controlled, double-blind, multicenter clinical trial. TNF-alpha MAb Sepsis Study Group. JAMA 1995;273:934941.Google Scholar
5.Zeni, F, Freeman, B, Natanson, C. Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 1997;25:10951100.CrossRefGoogle ScholarPubMed
6.Centers for Disease Control. Increase in National Hospital Discharge Survey rates for septicemia—United States, 1979-1987. MMWR 1990;39:3134.Google Scholar
7.Reynolds, HN, Haupt, MT, Thill-Baharozian, MC, Charlson, RW. Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 1988;260:34463450.Google Scholar
8.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.Google Scholar
9.Edbrooke, DL, Hibbert, CL, Kingsley, JM, Smith, S, Bright, NM, Quinn, JM. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999;27:17601767.CrossRefGoogle Scholar
10.Ridley, S, Biggam, M, Stone, P. A cost-benefit analysis of intensive therapy. Anaesthesia 1993;48:1419.CrossRefGoogle ScholarPubMed
11.Rentz, AM, Halpern, MT, Bowden, R. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998;27:781788.CrossRefGoogle ScholarPubMed
12.Sands, KE, Bates, DW, Lanken, PN, et al. Epidemiology of sepsis syndrome in eight academic medical centers. JAMA 1997;278:234240.Google Scholar
13.Bates, DW, Sands, K, Miller, E, et al. Predicting bacteremia in patients with sepsis syndrome. J Infect Dis 1997;176:15381551.Google Scholar
14.Bone, RC. Sepsis, the sepsis syndrome, multi-organ failure: a plea for comparable definitions. Ann Intern Med 1991;114:332333.Google Scholar
15.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal populations: development and validation. J Chronic Dis 1987;40:373383.Google Scholar
16.SAS Institute, Inc. SAS Procedures Guide, Release 6.12 Edition. Cary, NC: SAS Institute, Inc.; 1996.Google Scholar
17.Pittet, D, Rangel-Frausto, S, Li, N, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Medicine 1995;21:302309.Google Scholar
18.Wey, SB, Mori, M, Pfaller, MA, Woolson, RF, Wenzel, RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988;148:26422645.Google Scholar
19.Pittet, D, Thievent, B, Wenzel, RP, Li, N, Gurman, G, Suter, PM. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Medicine 1993;19:265272.Google Scholar
20.Angus, DC, Linde-Zwirble, WT, Lidicker, J, Clermont, G, Cardilo, J, Pinsky, MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:13031310.CrossRefGoogle ScholarPubMed