Long-term Clinical Outcomes and Health Care Costs of Canadian Adults with Sepsis: A Population-based, Retrospective Cohort Study
CCCF ePoster library. Thavorn K. 11/13/19; 283372; EP110
Dr. Kednapa Thavorn
Dr. Kednapa Thavorn
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Topic: Retrospective or Prospective Cohort Study or Case Series

Farrah, Kelly 1,2,3; McIntyre, Lauralyn 1,2,4; Coyle, Doug1; Talarico, Robert3,Thavorn,  Kednapa 1,2,3
1 School of Epidemiology and Public Health, University of Ottawa
2 Ottawa Hospital Research Institute, The Ottawa Hospital
3 ICES uOttawa, Institute for Clinical Evaluative Sciences
4 Division of Critical Care, The Ottawa Hospital

Background: Although the short-term mortality and healthcare costs for sepsis patients are known to be high, the long-term attributable mortality and costs of sepsis in Canada are unclear.
Objectives: To determine the attributable all-cause mortality and healthcare costs of sepsis patients compared to non-sepsis patients residing in Ontario.
Methods: We conducted a population-based retrospective cohort study and included a cohort of adult patients with sepsis (infection with organ dysfunction), infection alone (no organ dysfunction) and non-sepsis controls aged 18 years or older who were admitted to a hospital in Ontario between April 1, 2012 and March 31, 2016, with follow up to 31 March 2017. We used a validated Canadian method to define sepsis from health administrative data. Sepsis cases and hospitalized controls were matched 1:1 based on the propensity score, age, sex, type of admission, and date of admission. We used a conditional time to event analysis and generalized linear models to adjust for remaining confounders and to compare all-cause mortality, hospital readmissions, and health system costs associated with sepsis and non-sepsis patients.
Results: After matching, 248,612 pairs of cases and controls were included in the analysis, of which 82,211 had sepsis and 166,401 had infection alone. Over the 1-year follow-up period, sepsis and infection alone were associated with a higher risk of mortality compared to matched controls (HR 2.07, 95% CI:2.04-2.11 and HR 1.12, 95%CI: 1.11-1.14 respectively). Patients with both sepsis and infection alone had a higher risk of rehospitalization within 1-year of index admission discharge compared to matched controls, with odd ratios of 1.80 (95 %CI: 1.77-1.83) and 1.53 (95% CI: 1.52-1.54), respectively. Compared to matched controls, the incremental one-year health system costs for patients with sepsis and infection alone were C$30,974 and C$11,409, respectively.  
Conclusions: Compared to hospitalized controls, patients with sepsis were more likely to experience higher risks of death and hospital readmission and incur the greater health system costs. The annual 1-year attributable costs to the Ontario health system were estimated to be $637 million for sepsis patients and $475 million for patients with infection alone.



1. Jolley RJ, Quan H, Jetté N, Sawka KJ, Diep L, Goliath J, Roberts DJ, Yipp BG, Doig CJ. Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data. BMJ Open [Internet]. 2015 Dec 22 [cited 2018 Feb 9];5(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691777/ PMCID: PMC4691777

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