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Background: The effect of hospital spending on the mortality rate of patients with sepsis has not yet been fully elucidated. We hypothesized that hospitals that consume more medical resources would have lower mortality rates among patients with sepsis. Methods: This retrospective study used administrative data from 2010 to 2017. The enrolled hospitals were divided into quartiles based on average daily medical cost per sepsis case. The primary and secondary outcomes were the average in-hospital mortality rate of patients with sepsis and the effective cost per survivor among the enrolled hospitals, respectively. A multiple regression model was used to determine the significance of the differences among hospital categories to adjust for baseline imbalances. Fractional polynomials and restricted cubic splines were used to determine the significance of the association between hospital spending and in-hospital mortality. Subgroup and sensitivity analyses were performed for the primary outcome. Results: Among 997 hospitals enrolled in this study, the crude in-hospital mortality rates were 15.7% and 13.2% in the lowest and highest quartiles of hospital spending, respectively. After adjusting for confounding factors, the highest hospital spending group demonstrated a significantly lower in-hospital mortality rate than the lowest hospital spending group (coefficient = − 0.025, 95% confidence interval [CI] − 0.034 to − 0.015; p

We aimed to investigate the impact of hospital volume on the mortality rate and medical costs in sepsis. This retrospective study used the administrative data from 2010 to 2017. The hospital volume categorization into quartiles was performed according to the annual number of sepsis cases. The primary and secondary outcome was in-hospital mortality and medical costs, respectively. A mixed-effects logistic model with a two-level hierarchical structure was used to adjust for baseline imbalances. Among 1,781,014 sepsis patients from 1,622 hospitals, the crude in-hospital mortality rate was 22.1% and 17.0% in the lowest and highest quartile of sepsis volume, respectively (p

Background:Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined.Methods:We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to determine the significant predictors contributing to an increase in medical cost.Results:Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017 (rate = + $0.2 billion/year, p p p = 0.001). In the subgroup analysis, the gross medical cost of the late elderly (75 ≤ age) showed the highest coefficient throughout the time period, despite the lowest medical cost per person. While gender (male), number of chronic diseases, intensive care unit (ICU) admission, length of hospital stay, and site of infection (blood, heart, and meninges/brain/spinal cord) contributed to an increase in medical costs, an increase in age, admission year, and other types of infection (abdominal, bone and soft tissue, respiratory, and urogenital) were significant predictors of reduced medical costs.Conclusions:We demonstrated an increase in annual gross medical costs with an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. Among the various factors altering medical costs, gender (male), number of chronic diseases, ICU admission, length of hospital stay, and specific types of infection were associated with increased medical expenses.

Background Trends in the incidence and outcomes of sepsis using a Japanese nationwide database were investigated. Methods This was a retrospective cohort study. Adult patients, who had both presumed serious infections and acute organ dysfunction, between 2010 and 2017 were extracted using a combined method of administrative and electronic health record data from the Japanese nationwide medical claim database, which covered 71.5% of all acute care hospitals in 2017. Presumed serious infection was defined using blood culture test records and antibiotic administration. Acute organ dysfunction was defined using records of diagnosis according to the international statistical classification of diseases and related health problems, 10th revision, and records of organ support. The primary outcomes were the annual incidence of sepsis and death in sepsis per 1000 inpatients. The secondary outcomes were in-hospital mortality rate and length of hospital stay in patients with sepsis. Results The analyzed dataset included 50,490,128 adult inpatients admitted between 2010 and 2017. Of these, 2,043,073 (4.0%) patients had sepsis. During the 8-year period, the annual proportion of patients with sepsis across inpatients significantly increased (slope = + 0.30%/year, P P = 0.0001), accounting for 7.8 deaths per 1000 inpatients in 2017. The in-hospital mortality rate and median (interquartile range) length of hospital stay significantly decreased (P Conclusions The Japanese nationwide data indicate that the annual incidence of sepsis and death in inpatients with sepsis significantly increased; however, the annual mortality rates and length of hospital stay in patients with sepsis significantly decreased. The increasing incidence of sepsis and death in sepsis appear to be a significant and ongoing issue.