The Effects of Postacute Rehabilitation on Mortality, Chronic Care Dependency, Health Care Use, and Costs in Sepsis Survivors

Sepsis often leads to long-term functional deficits and increased mortality in survivors. Post-acute rehabilitation can decrease long-term sepsis mortality, but its impact on nursing care dependency, health care use and costs is insufficiently understood.To assess the short-term (7-12 months post-discharge) and long-term (13-36 months post-discharge) effect of inpatient rehabilitation within six months after hospitalization on mortality, nursing care dependency, health care use and costs.Observational cohort study using health claims data from the health insurer AOK (Allgemeine Ortskrankenkasse). Among 24.3 million AOK beneficiaries, we identified adult beneficiaries hospitalized with sepsis in 2013/14 by explicit ICD-10 codes. We included patients who were non-employed pre-sepsis, for whom rehabilitation is reimbursed by the AOK and thus included in the dataset, and who survived at least six months post-discharge. The effect of rehabilitation was estimated by statistical comparisons of patients with rehabilitation (treatment group) and those without (reference group). Possible differential effects were investigated for the subgroup of Intensive Care Unit (ICU)-treated sepsis survivors. We used inverse probability of treatment weighting based on propensity scores to adjust for differences in relevant covariates. Costs for rehabilitation in the six months post-sepsis were not included in the costs analysis.Among 41,918 six-months sepsis survivors, 17.2% (n=7,224) received rehabilitation. There was no significant difference in short-term survival between survivors with and without rehabilitation. Long-term survival rates were significantly higher in the rehabilitation group (90.4% vs. 88.7% (odds ratio [OR]=1.2 95% confidence interval [CI], 1.1-1.3) p=0.003)). Survivors with rehabilitation had a higher mean number of hospital readmissions (7-12 months after sepsis, 0.82 vs. 0.76, p=0.014) and were more frequently dependent on nursing care (7-12 and 13-36 months after sepsis, 47.8% vs. 42.3%, OR=1.2 (95% CI, 1.2-1.3), p0.001, and 52.5% vs. 47.5%, OR=1.2 (95% CI, 1.1-1.3), p0.001, respectively) compared to those without rehabilitation, while total health care costs 7-36 months did not differ between groups. ICU-treated sepsis patients with rehabilitation had higher short and long-term survival rates (93.5% vs. 90.9%, OR=1.5 (95% CI, 1.2-1.7), p0.001; 89.1% vs. 86.3%, OR= 1.3 (95% CI, 1.1-1.5), p0.001, respectively) than ICU-treated sepsis patients without rehabilitation.Rehabilitation within the first 6 months after ICU- and non-ICU treated sepsis is associated with increased long-term survival within three years after sepsis without added total health care costs. Future work should aim to confirm and explain these exploratory findings.