Background: Sepsis is a leading health care burden associated with high mortality in the United States. Poor outcomes associated with sepsis continue despite modifications in the sepsis care guidelines. Several factors influence the outcome of sepsis including patient characteristics, etiology of sepsis, and management in the appropriate intensive care unit setting. The aim of our study is to investigate the effect of hospital teaching status on the outcomes of sepsis.
Methods: We queried the National Inpatient Sample (NIS) 2016, 2017, and 2018 databases. The NIS is the largest inpatient hospitalization database in the United States. The numbers in the database are weighted to optimize national estimates. The NIS was searched for hospitalization of adult patients with sepsis as a principal diagnosis using ICD-10 codes, this was further categorized based on hospital teaching status where patients were admitted. The primary outcome was inpatient mortality while secondary outcomes included the length of stay (LOS) in days, total hospital cost (THC) in dollars. STATA software was used for data analysis. Cofounders adjusted with multivariable logistic and linear regression analysis.
Results: There were about 3,935,528 adult hospitalizations principally for sepsis, of which 37.5% were admitted at non-teaching hospitals and 62.5% were admitted to teaching hospitals. The majority of the patients admitted to non-teaching hospitals were slightly older (66.5 vs 64.6 years on average) compared to those admitted to teaching hospitals. The overall inpatient mortality was 9.7% (382,765) for hospitalizations due to sepsis, Compared with patients in nonteaching hospitals, those in teaching hospitals had higher mortality ( 10.3% vs 8.7%), septic shock (21.6% vs 18%), acute kidney injury (40.6% vs 37.3%), adult respiratory distress syndrome (0.69% vs 0.57%), and arrhythmias (24.7% vs 24.6%)(Table 1). Patients in teaching hospitals had a mean adjusted increase in LOS of 1.3 days (95% CI: 1.2–1.4, p< 0.001) and an increase in total hospital cost of $15962 (95% CI: 13,552- 18,373, p< 0.001) compared to those in non-teaching hospitals.
Conclusions: In conclusion, adult patients hospitalized in a teaching hospital with a principal diagnosis of sepsis have worse outcomes, including inpatient mortality. More research is needed to elucidate the apparent poor outcomes and associated factors in this population.
