NEW YORK (Reuters Health) – Unplanned 30-day readmissions are common after sepsis hospitalizations, according to data from the Nationwide Readmissions Database.

“The most interesting finding is that sepsis is the leading cause of 30-day readmissions in the U.S.,” Dr. Sachin Yende from VA Pittsburgh Healthcare System in Pennsylvania told Reuters Health by email. “Furthermore, readmissions following sepsis also cost more compared to readmissions following heart failure, heart attack, COPD, and pneumonia. Thus, sepsis accounts for a significant proportion of costs of readmissions.”

As part of its pay-for-performance program, the Centers for Medicare & Medicaid Services tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, COPD, and pneumonia, but not sepsis. The proportion and cost of unplanned readmissions following sepsis hospitalization were unknown until now.

To investigate, Dr. Yende and colleagues used data from the 2013 Nationwide Readmissions Database. Sepsis accounted for 12.2% of the more than 1.1 million unplanned 30-day readmissions, far more than readmissions after hospitalizations for AMI (1.3%), heart failure (6.7%), COPD (4.6%), or pneumonia (5.0%). Sepsis patients commonly had additional diagnoses, including AMI (0.7%), heart failure (3.4%), COPD (3.3%), and pneumonia (7.5%), the researchers report in JAMA, online January 22.

Durations of unplanned readmissions were longer following sepsis hospitalization than readmissions following AMI, heart failure, COPD, and pneumonia, and the estimated mean cost per readmission was significantly higher for sepsis ($10,070) than for AMI ($9424), heart failure ($9051), COPD ($8417), or pneumonia ($9533).

“There are recent studies showing that since the hospital readmission reduction program (HRRP) started, readmissions for heart failure, COPD, pneumonia, and heart attack have decreased,” Dr. Yende said.

“Whether adding sepsis readmissions to HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions (e.g., infections) and that most patients would prefer to avoid admission to the hospital,” he said.

“Although sepsis is an acute condition, it has long-term sequelae that last long after hospital discharge,” he concluded. “Thus, providers should consider developing programs/interventions to reduce these sequelae.”

Dr. Hallie Prescott from the University of Michigan Health System and VA Ann Arbor Healthcare System told Reuters Health by email, “We also know that a high proportion of these readmissions after sepsis are potentially preventable—suggesting that there may be an opportunity for improvement.”

“When treating sepsis survivors in clinic after hospitalization, we should focus our attention to common, treatable conditions that account for many of these readmissions—such as recurrent infection, heart failure exacerbation, renal failure, and aspiration,” said Dr. Prescott, an expert in pulmonary and critical care, who was not involved in the study.