重症脓毒症再次入院课件.pptVIP

4、severe sepsis survivors are less likely to be readmitted if they are older than 80 years. As increasing age, in general , leads to increased frailty, it is possible that this observed relationship has to do with palliative care-related decisions and subsequent readmission avoidance more likely to be discharged to hospice 5、We speculated that acute organ failure would be associated with 30-day readmission risk due to the likelihood of diminished functional status in multiple organ failure survivors ; however, in the multivariate model, acute organ failure was not predictive. One potential explanation for this observation is that the cohort of sepsis patients with the most severe organ failure are logically at greatest risk of death during the index hospitalization and thus not eligible for readmission. 6、 there is evidence that hospital case volume is inversely related to severe sepsis mortality，a common assertion used to explain the volume-mortality relationships in critical illness is that high volume centers possess greater expertise and resources, it may be expected that index hospitalization at high-volume centers would associate with less readmissions. First, the inability to adequately control for severity of illness in ICU patients in administrative datasets introduces the possibility of confounding. Second the reduced mortality rates at high-volume centers result in more readmissions because they save more patients from death. Finally, better-resourced, high-volume hospitals are more likely to receive inter-hospital transfers than low-volume hospitals. CONCLUSIONS we found that 30- and 180-day readmissions are common in severe sepsis survivors and are associated with some factors Readmissions after severe sepsis hospitalization result in substantial mortality and cost The majority of readmissions are generated by a minority of sepsis survivors who are of black race, are Medicare/Medicaid recipients, and carry a substantial comor