Abstract Rationale Declining hospital mortality trends among critically ill (i.e., intensive care unit ICU) patients with sepsis have resulted in increasing numbers of survivors with significant morbidity following hospital discharge; this group is vulnerable to hospital readmission and has high one-year mortality risk. Especially for those at risk of death in the year following discharge, optimizing health-related quality of life is essential. Time spent out of the hospital (i.e., hospital-free days HFDs) is an increasingly popular patient-centered outcome but has yet to be characterized among older adults who survive a sepsis-related ICU hospitalization. Methods We used Centers for Medicare and Medicaid Services inpatient claims data from 2016-2021 to identify older adults (≥65 years) hospitalized with sepsis requiring ICU-level care. After excluding those that died during hospitalization (19%) or were discharged to hospice (10%), our analytic cohort comprised survivors of sepsis-related critical illness. We used inpatient claims following the date of discharge through 365-day follow-up to create the dependent variable, HFD365. We calculated descriptive statistics and compared median HFD365 by various characteristics using Wilcoxon rank-sum and Kruskal-Wallis tests, among the entire cohort and then restricted to those who died during follow-up. Analyses were conducted using Stata 16.1. Results Our final dataset included 1,413,334 survivors (age 77.4±8.2 years; 50.1% female; 11% Black, 9% Hispanic, 3% Asian; median ICU length of stay 4 days). Half were discharged home with/without home health services and one-third were discharged to skilled nursing facilities. Nearly 60% were hospitalized in the year following discharge. One-third of the cohort died during follow-up and had a median HFD365=57; in unadjusted analyses, HFD365 was significantly lower (p 0.001) for patients frail on admission (48 vs. 63), who received mechanical ventilation (30 vs. 64), whose ICU length of stay exceeded 3 days (50 vs. 69), and who were discharged to a non-home location (44 vs. 91). These unadjusted differences were retained when comparisons were expanded to include the entire cohort. Conclusions Among older adult survivors of sepsis-related critical illness in the US, one in three died in the year following hospital discharge and spent a median of just under two months alive and at home in the year following discharge. Characterizing acute care utilization following hospitalization can help inform goals of care discussions during sepsis/ICU hospitalization and help align post-acute care with patient values/preferences. Examining predictors of HFDs in future adjusted analyses can focus interventional efforts to improve care coordination/post-acute care follow-up. This abstract is funded by: National Institute of Nursing Research (T32NR014205)
DeForge et al. (Fri,) studied this question.