Sepsis survivors treated with rehabilitation linked to higher 3-year survival rates

Key takeaways:

• Long-term survival rates were greater when rehabilitation started within 6 months of hospital discharge.
• Fewer ICU-treated sepsis survivors with vs. without rehabilitation were in nursing homes.

Sepsis survivors from ICU and non-ICU settings treated with rehabilitation within 6 months had greater survival rates within 3 years following hospitalization, according to results published in Annals of the American Thoracic Society.

Further, patients who received rehabilitation had similar total health care costs to those who did not receive rehabilitation within the 3 years following their hospitalization, according to researchers.

“We found long-term survival benefits in survivors who received rehabilitation in the 6 months after hospital discharge, although these survivors had higher rates of hospital readmissions (6-12 months after sepsis) and more frequently had nursing care levels (7-12 and 13-36 months after sepsis) compared with those without rehabilitation,” Daniel Winkler, doctoral student in the Institute of Infectious Diseases and Infection Control at Jena University Hospital in Germany, and colleagues wrote.

In a retrospective observational cohort study, Winkler and colleagues analyzed 41,918 patients who survived sepsis after hospitalization between 2013 and 2014 in Germany, identified through health claims data, to look at the impact rehabilitation treatment within 6 months had on mortality, nursing care dependency, health care use and costs over short-term (7-12 months after discharge) and long-term (13-36 months after discharge) periods.

Researchers compared sepsis survivors who received rehabilitation with a reference group of sepsis survivors who did not receive rehabilitation to evaluate how this treatment influenced factors after hospital discharge.

Further, researchers used inverse probability of treatment weighting to account for differing covariates, such as age, sex and preexisting comorbidities.

Of the total cohort, 7,224 (mean age, 72 years; 47.1% women) received post-acute rehabilitation and 34,694 (mean age, 72.9 years; 52% women) patients made up the reference group.

In terms of mortality, patients receiving rehabilitation had greater long-term survival rates than those without rehabilitation (90.4% vs. 88.7%; OR = 1.2; 95% CI, 1.1-1.3; P = .003), but short-term survival rates did not differ between groups.

Although hospital readmissions did not differ between groups in the long-term, researchers observed that in the short-term period those with rehabilitation had an increased average number of readmissions (0.82 vs. 0.76; effect size, 7.9; 95% CI, 1.6-14.3; P = .004) and more average days at the hospital during rehospitalization (9.9 days vs. 8.6 days; effect size, 14.5; 95% CI, 4.5-24.6; P = .004).

Compared with patients who did not receive rehabilitation, researchers found that patients with rehabilitation had higher levels of nursing care dependency in the short-term (47.8% vs. 42.3%; OR = 1.2; 95% CI, 1.2-1.3; P < .001), as well as in the long-term (52.5% vs. 47.5%; OR = 1.2; 95% CI, 1.1-1.3; P < .001).

Across both time periods after discharge, there was no difference between those with and without rehabilitation in terms of mean total health care costs, according to researchers.

In a subgroup analysis of 12,690 sepsis patients treated in the ICU, 4,082 received rehabilitation.

Within this cohort of ICU-treated patients, those with rehabilitation had greater survival rates than those without rehabilitation over short-term (93.5% vs. 90.9%; OR = 1.5; 95% CI, 1.2-1.7; P < .001) and long-term (89.1% vs. 86.3%; OR = 1.3; 95% CI, 1.1-1.5; P < .001) periods following discharge, according to researchers.

Additionally, researchers observed that fewer ICU-treated patients with rehabilitation were admitted in nursing homes in the short-term (10% vs. 12.8%; OR = 0.8; 95% CI, 0.7-0.9) and long-term (13.1% vs. 15.9%; OR = 0.8; 95% CI, 0.7-0.9).

Researchers noted that these findings demonstrate that rehabilitation has different influences on survival and nursing home admissions depending on whether sepsis patients are treated in the ICU or not.

“The empirical findings of this study support the hypothesis that rehabilitation can improve survival of sepsis survivors without added costs,” Winkler and colleagues wrote. “This encourages efforts to improve rehabilitation services for sepsis survivors and maximize attendance to reduce the long-term mortality of sepsis survivors. Further research is needed to ensure causality and to better understand the association of postsepsis rehabilitation with increased rates of rehospitalization and allocation of nursing care levels, and whether these may contribute to a closer monitoring and earlier treatment of complications after sepsis.”