The association of teaching status on inpatient mortality among critically ill patients with sepsis

SESSION TITLE: Critical Care Posters 11 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: The organizational structure and operation of teaching hospitals differ from nonteaching hospitals, which leads to common differences to include, but are not limited to, cost, patient characteristics, resources and outcomes (1,2). This research aims to explore and understand the outcomes of sepsis, a common cause of in-hospital mortality, in critically ill patients, in teaching versus nonteaching hospital settings. METHODS: The National Inpatient Sample between 2008 and 2017 was queried for all non-surgical discharges with a primary or secondary diagnosis of sepsis among patients aged 18 years or older, who were critically ill, requiring mechanical ventilation during their hospital stay. We compared inpatient mortality among patients who were treated at teaching hospitals to nonteaching hospitals. Adjusted logistic regressions were used to compare outcomes adjusting for age, sex, comorbidity, race, socioeconomic factors, and hospital factors. RESULTS: There were 3,375,039 weighted discharges over the study period, of which 2,051,336 were admitted to teaching hospitals (60.8%). Overall, 46.4% of patients were female, and 62.5% were aged above 60 years old. Patient demographics and comorbidity profiles were similar between groups. Among all patients, the most common principal diagnoses were septicemia and respiratory failure (ICD-10 J96.X and ICD-9 518.X). There was a higher 2% unadjusted absolute mortality hospitals at teaching hospitals compared to nonteaching hospitals (41.0% vs. 39.1%, p<0.0001). In the adjusted regression model, there was 17% increased odds of mortality at teaching hospitals (OR 1.17 05% CI [1.15, 1.19]). CONCLUSIONS: Although prior studies have shown a lower mortality for common conditions in teaching hospitals, our data demonstrate a consistently higher mortality at teaching hospitals among intubated, critically ill patients with sepsis. Though these differences may be mediated by higher severity of illness, these findings warrant further investigation to understand why these differences exist. CLINICAL IMPLICATIONS: Sepsis is a major problem in the medical ICU, and in US hospitals. It is a leading cause of mortality and among the most expensive treated conditions. The incidence is increasing, and it continues to negatively impact the ICU. Understanding the factors that drive differences in outcomes between teaching and nonteaching hospitals can help to mitigate these differences, to preclude any public perception bias, eliminate insurance coverage preference, and help to standardize care across the US health system. DISCLOSURES: No relevant relationships by Raymonde Jean No relevant relationships by Raymond Jean No relevant relationships by Lorenzo Leys No relevant relationships by Sara Luby No relevant relationships by Deepanjali Radhakrishnan Nair No relevant relationships by Sidra Salman