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Discharge trends for septic shock survivors remain steady



– While septic shock mortality has decreased since the Surviving Sepsis Campaign guidelines were introduced, discharge trends for survivors have not changed significantly over time, a recent analysis suggests.

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The percentage of survivors discharged to subacute rehab or long-term facilities did not change appreciably over time, according to the 10-year retrospective analysis, presented at the annual meeting of the American College of Chest Physicians.

However, average length of stay did significantly trend downward over the decade analyzed, while total charge per septic shock admission significantly increased, according to investigator Di Pan, DO, Icahn School of Medicine at Mount Sinai, New York, and his colleagues.

This is one of few studies looking at outcomes in survivors of septic shock, as most analyses have primarily focused on mortality outcomes, the investigators said.

Their analysis was based on the 2004 to 2014 National (Nationwide) Inpatient Sample databases and included patients with a primary diagnosis of septic shock at discharge.

Out of nearly 1.8 million patients with septic shock in that cohort, about 1 million survived, according to data Dr. Pan and colleagues provided in an abstract of the presentation.

In-hospital mortality decreased from 51.7% in 2004 to 39.3% in 2014 (P less than .001), the investigators reported.

The proportion of survivors discharged to subacute rehab or long-term acute care facilities was 61.9% in 2004, and similarly, 62.4% in 2014 (P = .1), while the percentage discharged home was 17.1% in 2004 and 15.1% in 2014 (P = 0.55).

However, there was a small but statistically significant downtick in mean length of stay, from 12.6 days in 2004 to 11.05 days in 2014, the investigators said. Meanwhile, total hospitalization charges surged from $105,776 in 2004 to $134,394 over the same time period.

The first edition of the Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock was published in March 2004 in Critical Care Medicine.

Future studies and clinical trials should look beyond mortality outcomes to additionally evaluate morbidity outcomes in septic shock survivors, Dr. Pan and coauthors said in their report.

The researchers had no relationships to disclose relevant to the presented study.

SOURCE: Pan D et al. CHEST 2018. doi: 10.1016/j.chest.2018.08.339.

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