Population Burden of Long‐Term Survivorship After Severe Sepsis in Older Americans

<jats:sec><jats:title>Objectives</jats:title><jats:p>To ascertain the absolute number of <jats:styled-content style="fixed-case">M</jats:styled-content>edicare beneficiaries surviving at least 3 years after severe sepsis and to estimate their burden of cognitive dysfunction and disability.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort analysis of <jats:styled-content style="fixed-case">M</jats:styled-content>edicare data.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>All short‐stay inpatient hospitals in the <jats:styled-content style="fixed-case">U</jats:styled-content>nited <jats:styled-content style="fixed-case">S</jats:styled-content>tates, 1996 to 2008.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Individuals aged 65 and older.</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Severe sepsis was detected using a standard administrative definition. Case‐fatality, prevalence, and incidence rates were calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Six hundred thirty‐seven thousand eight hundred sixty‐seven <jats:styled-content style="fixed-case">M</jats:styled-content>edicare beneficiaries were alive at the end of 2008 who had survived severe sepsis 3 or more years earlier. An estimated 476,862 (95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) = 455,026–498,698) had functional disability, with 106,311 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 79,692–133,930) survivors having moderate to severe cognitive impairment. The annual number of new 3‐year survivors after severe sepsis rose 119% during 1998 to 2008. The increase in survivorship resulted from more new diagnoses of severe sepsis rather than a change in case‐fatality rates; severe sepsis rates rose from 13.0 per 1,000 <jats:styled-content style="fixed-case">M</jats:styled-content>edicare beneficiary‐years to 25.8 (<jats:italic>P</jats:italic> < .001), whereas 3‐year case fatality rates changed much less, from 73.5% to 71.3% (<jats:italic>P</jats:italic> < .001) for the same cohort. Increasing rates of organ dysfunction in hospitalized individuals drove the increase in severe sepsis incidence, with an additional small contribution from population aging.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Sepsis survivorship, which has substantial long‐term morbidity, is a common and rapidly growing public health problem for older <jats:styled-content style="fixed-case">A</jats:styled-content>mericans. There has been little change in long‐term case‐fatality, despite changes in practice. Clinicians should anticipate more‐frequent sequelae of severe sepsis in their patient populations.</jats:p></jats:sec>