Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005–2010
| Autor: | Joshi Kp, Nguyen Hb, Jim E. Banta, Beeson L |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Patient demographics Critical Care and Intensive Care Medicine Logistic regression Severity of Illness Index California Sepsis Young Adult medicine Humans Hospital Mortality Severe sepsis Aged Retrospective Studies Aged 80 and over Medical Audit business.industry Regression analysis Emergency department Middle Aged medicine.disease Patient Discharge Hospitalization Cross-Sectional Studies Logistic Models Emergency medicine Female business Medicaid Comorbidity index |
| Zdroj: | Critical Care Medicine. 40:2960-2966 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0b013e31825bc92f |
| Popis: | OBJECTIVES The primary objective of this study was to identify which patient demographic, patient health, and hospital characteristics were associated with in-hospital mortality. A secondary objective was to determine the relative influence of these characteristics on mortality. DESIGN AND SETTING Public-use data for 2005-2010 were used in this retrospective, cross-sectional analysis of discharges from nonfederal, general acute hospitals in California. A staged logistic regression approach was used to examine the relative influence of variables associated with in-hospital mortality. PATIENTS A total of 1,213,219 patient discharges for adults (aged ≥18 yrs) having International Classification of Diseases-9 diagnosis and procedure codes indicating severe sepsis. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patient demographics (age, gender, race, ethnicity, and payer category), patient health status (acute transfer, Charlson-Deyo comorbidity index, and organ failures), and hospital characteristics (ownership type, teaching status, bed size, annual patient days, acute discharges, emergency department visits, inpatient surgeries, severe sepsis as a percentage of all discharges, and year) were obtained from the California Office of Statewide Health Planning and Development. Overall, in-hospital mortality was 17.8%. There was a steady annual increase in the number of sepsis discharges, but a decrease in mortality throughout the study period. Mortality increased with age and was associated with white race, and Medicaid (Medi-Cal) and private insurance. Patient health status additionally explained inpatient mortality. Hospital volume measures were statistically significant in regression analysis, whereas static structural measures were not. There were modest associations between measures of annual treatment volume and likelihood of inpatient mortality, notably decreasing likelihood with more acute discharges and with greater severe sepsis volume. CONCLUSIONS Although patient demographics and health status are the most important predictors of in-hospital mortality of patients with severe sepsis, hospital characteristics do play a substantial role. Findings regarding hospital volume can be used to improve processes and improve patient outcomes. |
| Databáze: | OpenAIRE |
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