AHRQ Issues Report to Congress on Burden of Sepsis in U.S. Hospital Care

The number of sepsis-related inpatient stays at non-federal acute care hospitals in the United States increased from 1.8 million in 2016 to 2.5 million in 2021, with a faster rate of increase following the emergence of COVID-19 in 2020, according to a report to Congress issued today by the Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services (HHS). The COVID 19 pandemic led to a noticeable rise in sepsis-related hospitalizations, hospital costs, and in-hospital mortality, particularly for patients with a COVID-19 diagnosis.

The report, titled “An Assessment of Sepsis in the United States and its Burden on Hospital Care,” responds to language in the Joint Explanatory Statement that accompanied the Consolidated Appropriations Act for Fiscal Year 2023, which directed the agency to conduct a comprehensive set of studies that calculate the morbidity, hospital readmissions, and mortality related to sepsis.  The report examines sepsis among all patients as well as among specific patient populations, including adults, pregnant women, children, and newborns.  The report also examines the association of pandemic-related changes in the healthcare system with the burden of sepsis.

Sepsis is a dysregulated systemic inflammatory response to infection that results in tissue damage and organ failure and can lead to death. It is one of the most expensive conditions treated in hospitals in the United States. Anyone can develop sepsis, but it disproportionately affects older adults, those with significant comorbidities, impaired immune function, and specific conditions like cancer, chronic lung disease, and heart failure. It can begin suddenly and requires urgent medical care.

"AHRQ's report to Congress highlights health disparities and geographic variation in sepsis caseloads, in-hospital mortality rates, and total hospital costs, which are all opportunities for targeted initiatives to improve patient outcomes and reduce financial strain on healthcare institutions," said AHRQ Director Dr. Robert Valdez. "Improving the quality of sepsis care for patients and reducing the burden of sepsis on the hospital system will also require continued investments by federal, state, and non-governmental entities to further strengthen the surveillance and quality improvement systems to ensure access to evidence-based care and resources for patients with sepsis."

The report found that hospital emergency departments served as the entry point for most inpatient admissions related to sepsis. Detailed analyses on hospital use related to sepsis underscore its burden on hospital systems, and include:

• National trends in sepsis-related hospital utilization, morbidity, and in-hospital mortality, as well as trends for key patient populations, including adults, pregnant women, children, and newborns.
• Disparities in hospital utilization for sepsis and associated outcomes by patient race and ethnicity, sex, residence in socially vulnerable communities, and urban/rural location.
• State variation in hospital utilization for sepsis and associated costs, and in-hospital mortality rate.

Today's report is the result of an extensive analysis of data from the AHRQ's Healthcare Cost and Utilization Project (HCUP).  HCUP is the largest and most comprehensive set of all hospital encounters (regardless of the expected payer of care including self-pay and uninsured) from all acute care, non-federal hospitals in 48 states plus the District of Columbia. HCUP is possible as a result of the voluntary federal-state-industry partnership with state data organizations. The report utilizes state-level and nationally representative HCUP data from 2016 to 2021 to present information on sepsis-related hospitalizations and emergency department visits at non-federal acute care hospitals in the United States.

Additional research on the burden of sepsis in acute, post-acute, and ambulatory settings is needed to better understand its root causes and long-term impacts for patients and healthcare providers in the United States. Over the last month, AHRQ has issued a series of new statistical briefs on sepsis to support further understanding and research on the topic, including:

• Overview of Outcomes for Inpatient Stays Involving Sepsis, 2016–2021 (PDF file, 1.1 MB), Appendix (PDF file, 811 KB)
• Racial and Ethnic Differences in Inpatient Stays Involving Sepsis, 2016–2021 (PDF file, 876 KB), Appendix (PDF file, 868 KB)
• Rural and Urban Hospital Differences in Inpatient Stays Involving Sepsis, 2019 and 2021 (PDF file, 1.2 MB), Appendix (PDF file, 860 KB)
• State Variation in Inpatient Stays Involving Sepsis, 2021 (PDF file, 1.7 MB), Appendix A (PDF file, 939 KB), Appendix B (PDF file, 225 KB)