Hospitalizations for severe sepsis among Medicare beneficiaries

Severe sepsis (sepsis accompanied by organ dysfunction) is associated with increasing hospitalization and mortality rates among elderly persons. It has been associated with high resource use and costs typical of chronically critically ill patients. This paper examines how hospitalizations for this complicated form of sepsis differs from hospitalizations for non-complicated sepsis in elderly Medicare patients in terms of incidence, resource use, cost (Medicare covered charges), in-hospital mortality and discharge destination. MEDPAR inpatient hospital discharge data for CY 2010 were examined for elderly Medicare fee-for-service beneficiaries hospitalized for sepsis (N=689,133). Patients with evidence of organ failure were classified as having severe sepsis (n= 474,830), representing 68.9% of all sepsis hospitalizations. The average age of patients with and without severe sepsis was similar (79 years old). Length of stay and total covered charges were higher for severe sepsis patients than for patients with uncomplicated sepsis (11.2 days vs. 7.2 days; $96,060 vs. $41,668). The percent of patients dying in-hospital was far greater for severe sepsis (27.7%) compared to uncomplicated sepsis patients (7.6%). While most live discharges were to a SNF for both severe and uncomplicated sepsis hospitalizations, patients with severe sepsis were more likely to be discharged to a long-term acute care hospital (LTCH) and less likely to be discharged to home or home health care. Cost of severe sepsis hospitalizations varied by discharge destination. Patients discharged to the following settings were especially costly; LTCH ($205,387), inpatient rehabilitation ($168,014), in-hospital death ($106,902), other facility types ($98,164) and SNF ($98,165).