ASSOCIATION OF TEACHING STATUS READMISSIONS AMONG CRITICALLY ILL PATIENTS WITH ACUTE RESPIRATORY FAILURE AND SEPSIS

SESSION TITLE: Critical Care Posters 11 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Hospital readmissions impact healthcare systems with a profound burden on cost and resource utilization. Given the high morbidity and mortality associated with acute respiratory failure and sepsis admissions, an investigation is warranted into the clinical factors associated with readmissions. Our study investigated predictors for readmission in critically ill patients with sepsis between teaching versus non-teaching hospitals. METHODS: We queried the National Readmissions Database between the months of January and September between 2010 and 2014 for non-surgical discharges with a primary or secondary diagnosis of sepsis among patients aged 18 years or older, who were critically ill and requiring mechanical ventilation. We compared unplanned 30-day and 90-day readmissions among patients who were treated at teaching hospitals in comparison to non-teaching hospitals. Adjusted logistic regressions were used to compare outcomes adjusting for age, sex, and Charlson comorbidity (CCI). RESULTS: There were 1,127,182 weighted discharges during the study period, of which 64.1% were at teaching hospitals. The population was primarily male (53.3%) and aged over 65 years (54.5%). Overall mortality for the cohort was 44.2%. On univariable analysis, there were no significant differences in mortality or readmissions between the teaching and non-teaching hospitals. After adjusted logistic regression, there were 8% (OR 1.08) and 9% (OR 1.09) increased odds for 30-day and 90-day readmissions, respectively, at teaching hospitals in comparison to non-teaching hospitals (both p<0.0001). CONCLUSIONS: Despite the absence of significant unadjusted differences in mortality or readmissions, our analysis demonstrated an 8% - 9% significantly higher odds of 30- and 90-day readmissions among patients initially treated at teaching hospitals, after accounting for other factors. These data demonstrate the higher resource burden borne by teaching hospitals for readmissions. As there is insufficient evidence to correlate these adjusted differences to worse hospital quality, further research is indicated to identify causative and modifiable risk factors for this higher readmission risk. CLINICAL IMPLICATIONS: Sepsis is a leading cause of hospital readmission, with a high-cost burden, relative to other critical care conditions (3). Our study demonstrates that teaching hospitals have a significantly higher odds of readmission when accounting for other clinical factors. DISCLOSURES: No relevant relationships by Idayat Brimah No relevant relationships by Subhash Chander No relevant relationships by Raymonde Jean No relevant relationships by Raymond Jean No relevant relationships by Lorenzo Leys No relevant relationships by Venus Sharma