10027/10876
Andrew Dick
Andrew
Dick
Hangsheng Liu
Hangsheng
Liu
Jack Zwanziger
Jack
Zwanziger
Eli Perencevich
Eli
Perencevich
E Yoko Furuya
E Yoko
Furuya
Elaine Larson
Elaine
Larson
Monika Pogorzelska-Maziarz
Monika
Pogorzelska-Maziarz
Patricia W Stone
Patricia W
Stone
Long-term survival and healthcare utilization
outcomes attributable to sepsis and pneumonia
University of Illinois at Chicago
2013
Community-associated infections
Sepsis
Pneumonia
Survival
Healthcare utilization
2013-12-06 00:00:00
Journal contribution
https://indigo.uic.edu/articles/journal_contribution/Long-term_survival_and_healthcare_utilization_outcomes_attributable_to_sepsis_and_pneumonia/10756688
Background: Hospital associated infections are major problems, which are increasing in incidence and very costly.
However, most research has focused only on measuring consequences associated with the initial hospitalization.
We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care
unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections
(CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term
survival and resource utilization; and how resource utilization was related to impending death during the
follow up period.
Methods: Clinical data and one year pre- and five years post-index hospitalization Medicare records were
examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art
econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual
eligibility) were controlled for in these models.
Results: In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects
accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the
pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P < 0.01; and
pneumonia HR = 1.58, P < 0.01) and the risk persisted throughout the follow-up period. Persons with sepsis and
pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis
ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death.
Conclusions: The infections had significant and lasting adverse consequences among the elderly. Yet, many of
these infections may be preventable. Investments in infection prevention interventions are needed in both
community and hospitals settings.