Review and Analysis of AHRQ report: Kelly Emrick MBA, Ph.D.
Sepsis, a life-threatening condition caused by the body’s extreme response to an infection, has become one of the most urgent and costly health issues facing the United States healthcare system. A recent report by the Agency for Healthcare Research and Quality (AHRQ), presented to Congress, offers a comprehensive overview of sepsis’s staggering impact on hospitals, patients, and the broader healthcare infrastructure. This blog investigates the report’s key findings, shedding light on the severity of sepsis, its prevalence, and the disparities in its treatment and outcomes.
Sepsis: A Growing Epidemic in Hospital Settings
According to the AHRQ report, sepsis-related hospitalizations in non-Federal acute-care hospitals have surged dramatically—from 1.8 million in 2016 to 2.5 million in 2021. This represents nearly a 40% increase in just five years. Sepsis is not only a common cause of hospitalization but also one of the most expensive conditions treated in U.S. hospitals. In 2021 alone, sepsis hospitalizations accounted for $52.1 billion in aggregate hospital costs or nearly 10% of all hospital expenses. The report emphasizes that early detection and treatment are crucial for improving outcomes. However, the complexity of sepsis diagnosis—due to its symptoms overlapping with many other conditions—makes timely intervention challenging. Emergency Departments (EDs) often serve as the entry point for sepsis care, with approximately 85.6% of sepsis-related hospitalizations originating from ED visits in 2021.
The Human Cost of Sepsis
Sepsis has a devastating impact on patient mortality and long-term health. In 2021, more than one in ten patients hospitalized for sepsis did not survive their hospital stay. For those suffering from septic shock—a severe form of sepsis characterized by dangerously low blood pressure—mortality rates are even higher, with one in three hospital encounters resulting in death. Survivors of sepsis often face a host of long-term complications, including cognitive impairments, physical disabilities, and a heightened risk of future health problems. The report also highlights the significant risk of hospital readmission for sepsis patients. Approximately 16% of sepsis patients are readmitted to the hospital within 30 days of discharge, a rate comparable to other serious conditions like heart failure and pneumonia. This high readmission rate underscores the need for improved post-discharge care and monitoring to support sepsis survivors. The AHRQ report reveals stark disparities in sepsis outcomes based on race, ethnicity, sex, and geography. Non-White patients, including Black, Hispanic, and American Indian populations, experience higher rates of sepsis-related hospitalizations and mortality compared to their White counterparts. In 2021, the in-hospital mortality rate for sepsis was significantly higher among patients living in the most socially vulnerable communities compared to those in less vulnerable areas. Geographical disparities are also evident. Rural hospitals, which often lack the resources and specialist care available in urban centers, see higher rates of inter-hospital transfers for sepsis patients. This can delay critical care and contribute to poorer outcomes. Moreover, the report notes that 85% of sepsis-related hospitalizations occur in urban hospitals, highlighting a potential concentration of resources that may not be equitably accessible to all populations.
The Impact of COVID-19 on Sepsis
The COVID-19 pandemic has fundamentally altered the landscape of sepsis care. The virus increased the incidence of viral sepsis, complicating diagnosis and treatment protocols traditionally focused on bacterial infections. The report notes that in 2021, hospitalizations for sepsis involving COVID-19 had higher mortality rates compared to those involving other pathogens. This shift has underscored the need for adaptable clinical guidelines and robust sepsis management strategies to respond to infectious diseases’ evolving nature. Addressing the burden of sepsis requires a multifaceted approach. The AHRQ report calls for ongoing investments in surveillance, research, and quality improvement initiatives. Efforts such as the Surviving Sepsis Campaign and the implementation of sepsis bundles—standardized sets of practices for the early identification and treatment of sepsis—have shown promise in reducing mortality rates. However, the report emphasizes that these guidelines must be continuously updated to reflect the latest evidence and tailored to address the unique needs of different patient populations, including those affected by COVID-19. State and local health departments also play a crucial role in sepsis management. The report highlights state-level initiatives to improve sepsis care, from regulatory mandates to voluntary quality improvement programs. These efforts are essential in reducing disparities and ensuring that all patients, regardless of location or background, have access to high-quality sepsis care.
Citation:
Agency for Healthcare Research and Quality. (2024). An assessment of sepsis in the United States and its burden on hospital care (AHRQ Publication No. 24-0087). U.S. Department of Health and Human Services. https://www.ahrq.gov/reports.html
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