The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions

Med Care. 2017 Apr;55(4):362-370. doi: 10.1097/MLR.0000000000000669.


Background: Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown.

Objectives: Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death.

Research design: Retrospective cohort study.

Subjects: A total of 17,716 30-day readmissions in an academic health system.

Measures: We used mixed-effects multivariable logistic regression models to identify risk factors associated with the primary outcome, in-hospital death, or transition to hospice during 30-day readmissions.

Results: Of 17,716 30-day readmissions, 1144 readmissions resulted in death or transition to hospice care (6.5%). Risk factors identified included: age, burden, and type of comorbid conditions, recent hospitalizations, nonelective index admission type, outside hospital transfer, low discharge hemoglobin, low discharge sodium, high discharge red blood cell distribution width, and disposition to a setting other than home. Sepsis (OR=1.33; 95% CI, 1.02-1.72; P=0.03) and shock (OR=1.78; 95% CI, 1.22-2.58; P=0.002) during the index admission were associated with the primary outcome, and in-hospital mortality specifically. In patients who died, infection was the primary cause for readmission in 51.6% of readmissions after sepsis and 28.6% of readmissions after a nonsepsis hospitalization (P=0.009).

Conclusions: We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Comorbidity
  • Female
  • Hospice Care*
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Pennsylvania
  • Retrospective Studies
  • Risk Factors
  • Sepsis / epidemiology*
  • Sepsis / mortality