Sepsis-related 30- and 90-day readmissions among patients with pancreatic cancer: A nationwide readmissions database analysis.

Abstract

e23240 Background: Pancreatic cancer is associated with high morbidity, frequent hospitalizations, and limited physiologic reserve. Sepsis is a common and life-threatening complication, often occurring in the setting of advanced disease, cancer-directed therapy, and biliary or gastrointestinal infections. While outcomes during index sepsis hospitalizations have been described, national data on short- and intermediate-term sepsis-related readmissions and their clinical and economic burden among patients with pancreatic cancer remain limited. Methods: We conducted a retrospective cohort study using the 2021–2022 Nationwide Readmissions Database (NRD). Adult, non-elective hospitalizations with a primary diagnosis of sepsis and secondary pancreatic cancer were identified using ICD-10 codes. December discharges were excluded for 30-day analyses, and October–December discharges were excluded for 90-day analyses to ensure complete follow-up. Index admissions were defined using a validated NRD algorithm. Sepsis-related readmissions were identified by ICD-10 sepsis codes during rehospitalization within 30 or 90 days, with only the first qualifying readmission counted. Primary outcomes were 30- and 90-day sepsis-related readmission rates; secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges. Results: For 30-day analyses, 26,534 weighted index hospitalizations were identified, of which 21,211 (80.0%) survived to discharge. The 30-day sepsis readmission rate was 8.2% (95% CI, 7.7–8.8). Mean age was 69 years, 55.8% were female, and 77.8% were treated at urban teaching hospitals. In-hospital mortality was 20.0% during index admissions and 16.3% among 30-day readmissions. Thirty-day readmissions accounted for 13,025 inpatient days (mean LOS 7.1 days) and $178 million in charges (95% CI, $157M–$198M). For 90-day analyses, 25,846 weighted index hospitalizations were identified, with 16,661 (64.4%) survivors eligible for follow-up. The 90-day sepsis readmission rate was 15.9% (95% CI, 14.6–17.2). Mortality among 90-day sepsis readmissions was 15.6% (95% CI, 13.7–17.6). These readmissions accounted for 18,682 inpatient days (mean LOS 7.0 days) and $253 million in charges (95% CI, $226M–$279M). Conclusions: Patients with pancreatic cancer hospitalized for sepsis experience substantial 30- and 90-day sepsis-related readmission rates, with high mortality, prolonged hospital stays, and significant healthcare costs. Nearly one in six patients surviving the index hospitalization was readmitted with sepsis within 90 days. These findings highlight vulnerability after sepsis hospitalization and underscore the need for improved post-discharge care coordination, infection surveillance, and transitional care strategies to reduce recurrent sepsis and readmissions.