Regional Differences and Mortality-associated Risk Factors among Older Patients with Septic Shock: Administrative...

Area of Science:

• Critical Care Medicine
• Geriatric Medicine
• Public Health

Background:

• Intensive care unit (ICU) policies and physician characteristics can influence patient mortality.
• Previous research has not specifically addressed septic shock in older adults or considered regional context effects on mortality.
• Regional disparities in healthcare outcomes are a growing concern.

Purpose of the Study:

• To investigate regional variability in 28-day mortality among older patients with septic shock.
• To identify factors associated with mortality, including physician characteristics and regional context.
• To assess the impact of intensivist availability on septic shock outcomes.

Main Methods:

• Analysis of administrative medical claims data from April 2015 to March 2020 in Fukuoka Prefecture, Japan.
• Classification of ICU physicians as 'intensivists' or 'ICU-dedicated physicians' based on board certification.
• Multilevel logistic regression to analyze 28-day mortality, adjusting for regional context effects.

Main Results:

• Mortality rates varied significantly across regions, ranging from 18.3% to 41.4%.
• Age, sex, postsurgical admission, and ICU beds per intensivist were associated with mortality.
• Having at least one intensivist per four ICU beds reduced mortality risk (OR 1.99, p=0.01).

Conclusions:

• Regional variability in mortality for older septic shock patients is confirmed, even after accounting for context.
• The presence of board-certified intensivists is a significant factor in reducing mortality.
• Adequate physician commitment (time, intensity, knowledge) is vital for improving outcomes in this patient population.