February 21, 2020 by Quinn Eastman, Emory
University
The number of elderly Americans hospitalized
for sepsis has surged in recent years, placing a significant financial strain
on the nation's health care providers, according to a new federal study led by
an Emory University critical care specialist Timothy Buchman, MD, PhD, FCCM.
The study is the first to analyze large
amounts of Medicare data related to sepsis,
a life-threatening condition caused by the body's extreme response to an
infection.
The analysis revealed a 40 percent increase in
the rate of Medicare beneficiaries hospitalized with sepsis over the past seven
years. That increase was faster than the overall growth in the Medicare
population, and the associated costs totaled more than $41 billion in 2018. Although
both short and long-term mortality remained high, they declined slightly during
the study.
The research team was led by Emory critical
care specialist Tim Buchman, who has been working with federal officials to assess the impact of
sepsis, one of the largest costs to hospitals and medical centers. Buchman says
that the general public may be familiar with sepsis as
something that a patient who is already in the hospital may contract, but that
is not the team's primary finding.
"The huge rise in admissions came from
patients who had sepsis when they arrived at the hospital," says Buchman.
It's an example of what happened to Buchman
while working on the study. In February 2019, while at a conference in
California, he became ill with an infection that led to his left leg turning
red and swelling to twice its normal size.
Prompt treatment with broad spectrum
antibiotics and intravenous fluids helped Buchman recover, but it reminded him
that "no matter who we are, where we are, and what we do, we are all
vulnerable to sepsis."
Buchman is editor-in-chief of Critical Care
Medicine and the federal study's results were published on February 14 in
three papers in that journal:
Sepsis Among Medicare Beneficiaries: 1. The Burdens of Sepsis, 2012–2018
Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018
Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018
Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018
Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018
The federal study was notable for both its
scope—it was the largest sepsis study based on contemporary Medicare data ever
published – and because it was conducted by an agency concerned with biomedical
threats such as emerging diseases and bioterrorism: BARDA, the Biomedical
Advanced Research and Development Authority.
"We were astonished by the study's
results," said Rick Bright, PhD, deputy assistant secretary for
preparedness and response in the Department of Health and Human Services and
director of BARDA. "To save lives in public health emergencies, we must
solve sepsis. The findings of this study have implications not only for patient
care, particularly after patients are discharged, but also for
investments by industry, non-government organizations and government
agencies."
The team's analysis documents high mortality
for patients hospitalized with sepsis. Ten percent of patients with non-severe
forms of sepsis died while in the hospital or within a week of discharge, and
60 percent with non-severe forms of sepsis died within three years.
Outcomes were worse among patients with the
most severe form of sepsis known as septic shock. Forty percent of these
patients died while in the hospital or within a week of being discharged, and
75 percent died within three years. The risk was greater for patients who had
other chronic health conditions.
The study did not pinpoint large differences
in previous medical history between people who were hospitalized for sepsis and
patients who were hospitalized for other reasons. However, diagnoses such as
pressure sores, time in a skilled nursing facility or use of other nursing
services did predict higher sepsis risk – an opportunity for future
intervention.
"Sepsis diagnoses in Medicare
beneficiaries thus may be a marker of deeper physiologic fragility as much as
it is an acute diagnosis," the authors conclude.
Over the last decade, federal officials have
been paying more attention to sepsis, introducing new quality measures,
detection tools and taking steps to facilitate antibiotic development. More
information about the federal study is available.
More information: Timothy G. Buchman et al. Sepsis Among
Medicare Beneficiaries: 1. The Burdens of Sepsis, 2012–2018 Critical Care
Medicine (2020). DOI: 10.1097/CCM.0000000000004224
Timothy G. Buchman et al. Sepsis Among
Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018 Critical
Care Medicine (2020). DOI: 10.1097/CCM.0000000000004226
Timothy G. Buchman et al. Sepsis Among
Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis,
2012–2018 Critical Care Medicine (2020). DOI: 10.1097/CCM.0000000000004225
Journal information: Critical Care Medicine
Provided by Emory University
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