Sepsis during short bowel syndrome hospitalizations: Identifying trends, disparities, and clinical outcomes in the United States

Table 1 Trends for short bowel syndrome hospitalizations and septic short bowel syndrome hospitalizations in the United States from 2005-2014

Years	Short bowel syndrome hospitalizations	Septic short bowel syndrome hospitalizations	% of sepsis in short bowel syndrome hospitalizations
2005	4199	20198	20.8
2006	3908	20206	19.3
2007	4083	20206	20.2
2008	5762	26411	21.8
2009	5869	25810	22.7
2010	5640	25423	22.2
2011	5805	27647	21.0
2012	5780	27015	21.4
2013	6105	26900	22.7
2014	6400	27280	23.5
Total	53550	247097	21.7

Table 2 Baseline hospitalization characteristics and clinical outcomes for septic and non-septic short bowel syndrome hospitalizations in the United States from 2005-2014

Variable	Non-septic short bowel syndrome hospitalizations	%	Septic short bowel syndrome hospitalizations	%	P value
Number of obs. (n)	193547	78.30	53550	21.70
Age, yr (mean ± SE)	58.0 ± 0.3	-	57.9 ± 0.2	-
Age, yr					< 0.0001
18-34	41979	21.70	10000	18.70
35-49	82308	42.50	24561	45.90
50-64	60113	31.10	17333	32.40
≥ 65	9149	4.70	1655	3.10
Gender					< 0.0001
Male	56601	29.30	17545	32.80
Female	136916	70.80	36005	67.20
Race					< 0.0001
White	130004	80.00	35660	77.30
Black	18436	11.30	5730	12.40
Hispanic	8866	5.50	3091	6.70
Others	5274	3.20	1651	3.60
Hospital location					< 0.0001
Rural	22155	11.50	4576	8.60
Urban nonteaching	70692	36.70	18187	34.10
Urban teaching	99780	51.80	30509	57.30
Hospital bed size					< 0.0001
Small	22978	11.90	5107	9.60
Medium	45289	23.50	11219	21.10
Large	124360	64.60	36946	69.40
Admission type					0.0100
Elective	157070	81.20	43201	80.70
Emergent or Urgent	36477	18.90	10349	19.30
Intestinal Transplant	430	0.22	178	0.33	< 0.0001
Disposition status					< 0.0001
Home	156802	81.10	34439	64.40
Facility	33898	17.50	14497	27.10
Inpatient mortality	2724	1.40	4537	8.50	< 0.0001
LOS, d (mean ± SE)	7.7 ± 0.1	-	16.1 ± 0.4	-	< 0.0001

LOS: Length of stay.

Table 3 Predictors of mortality for septic short bowel syndrome hospitalizations in the United States from 2005-2014

Characteristics/co-morbidities	Odds ratio (95% confidence interval)	P value
Age (yr)
18-44	5.85 (3.95-8.66)	< 0.0001
45-64	3.30 (2.37-4.59)	< 0.0001
65-84	1.75 (1.27-2.41)	0.001
≥ 85	Reference
Gender
Male	Reference
Female	1.18 (1.02-1.38)	0.030
Race
White	1.65 (1.17-2.33)	0.005
Black	1.28 (0.86-1.90)	0.220
Hispanic	1.22 (0.79-1.88)	0.360
Others	Reference
Hospital bed size
Small	1.16 (0.90-1.51)	0.250
Medium	1.10 (0.92-1.31)	0.320
Large	Reference
Hospital type
Rural	1.05 (0.79-1.38)	0.360
Urban non-teaching	0.94 (0.80-1.10)	0.420
Teaching	Reference
Median household income
Quartile 1	Reference
Quartile 2	0.96 (0.78-1.18)	0.690
Quartile 3	1.03 (0.83-1.27)	0.800
Quartile 4	1.18 (0.94-1.47)	0.150
Co-morbidities
Deficiency anemias	1.58 (1.35-1.85)	< 0.0001
Rheumatic disorders	1.20 (0.80-1.79)	0.380
Depression	1.66 (1.30-2.13)	< 0.0001
Drug abuse	1.51 (0.95-2.40)	0.090
Hypertension	1.16 (0.98-1.36)	0.080
Hypothyroidism	1.06 (0.83-1.34)	0.650
Lymphoma	2.48 (0.99-6.21)	0.050
Valvular disease	1.02 (0.73-1.41)	0.920

Table 4 Racial distribution of Elixhauser co-morbidities for septic short bowel syndrome hospitalizations in the United States from 2005-2014

Elixhauser co-morbidity	Whites	Blacks	Hispanics	Others	P value
Acquired immunodeficiency syndrome	0.0	1.0	0.3	0.0	< 0.0001
Alcohol abuse	1.6	2.4	0.8	1.4	< 0.0001
Deficiency anemias	38.8	49.0	45.4	37.6	< 0.0001
Rheumatic disorders	4.3	4.1	2.9	4.0	0.0040
Chronic blood loss anemia	2.1	2.1	2.3	3.2	0.0200
Congestive heart failure	11.2	10.8	8.6	9.8	< 0.0001
Chronic pulmonary disease	19.7	14.6	10.6	18.4	< 0.0001
Coagulopathy	15.4	16.9	19.1	16.9	< 0.0001
Depression	18.0	10.9	14.2	11.5	< 0.0001
Uncomplicated diabetes	11.4	14.4	17.7	17.0	< 0.0001
Diabetes with chronic complications	2.8	5.8	5.4	5.0	< 0.0001
Drug abuse	4.8	6.6	4.4	5.0	< 0.0001
Hypertension	32.4	42.5	34.5	34.6	< 0.0001
Hypothyroidism	13.5	10.4	8.8	8.6	< 0.0001
Liver disease	5.8	7.0	9.9	6.9	< 0.0001
Lymphoma	1.1	1.1	1.2	0.9	0.7500
Fluid and electrolyte disorders	57.5	62.5	61.2	58.2	< 0.0001
Metastatic cancer	4.5	4.4	5.2	8.6	< 0.0001
Neurological disorders	8.8	8.3	6.7	7.9	0.001
Obesity	5.6	6.3	5.7	6.9	0.0300
Paralysis	2.3	3.3	4.2	4.9	< 0.0001
Peripheral vascular disorders	6.8	7.4	7.0	6.5	0.4300
Psychiatric disorder	6.1	5.5	5.6	4.1	0.0030
Pulmonary circulation disorders	4.0	5.5	2.3	3.4	< 0.0001
Renal failure	21.2	30.7	16.7	18.8	< 0.0001
Solid tumor without metastasis	2.6	2.8	2.9	5.2	< 0.0001
Peptic ulcer disease excluding bleeding	0.1	0.1	0.1	0.0	0.3400
Valvular disease	5.2	4.8	3.8	5.3	0.0050
Weight loss	40.4	40.9	39.3	47.9	< 0.0001

Table 5 Gender distribution of elixhauser co-morbidities for septic short bowel syndrome hospitalizations in the United States from 2005-2014

Elixhauser co-morbidity	Male	Female	P value
Acquired immunodeficiency syndrome	0.3	0.1	< 0.0001
Alcohol abuse	2.9	1.0	< 0.0001
Deficiency anemias	36.8	39.7	< 0.0001
Rheumatic disorders	2.0	5.1	< 0.0001
Chronic blood loss anemia	1.9	2.1	0.0800
Congestive heart failure	10.7	10.8	0.9000
Chronic pulmonary disease	16.7	19.0	< 0.0001
Coagulopathy	16.8	15.0	< 0.0001
Depression	12.4	18.1	< 0.0001
Uncomplicated diabetes	12.6	11.6	0.0010
Diabetes with chronic complications	3.9	2.7	< 0.0001
Drug abuse	5.1	4.5	0.0010
Hypertension	33.6	32.1	0.0010
Hypothyroidism	6.0	14.9	< 0.0001
Liver disease	7.4	5.3	< 0.0001
Lymphoma	1.4	0.9	< 0.0001
Fluid and electrolyte disorders	56.6	57.9	0.0030
Metastatic cancer	4.9	4.4	0.0020
Neurological disorders	7.0	8.8	< 0.0001
Obesity	3.8	6.4	< 0.0001
Paralysis	3.5	2.1	< 0.0001
Peripheral vascular disorders	8.1	5.9	< 0.0001
Psychiatric disorder	4.7	6.3	< 0.0001
Pulmonary circulation disorders	4.2	3.8	0.0400
Renal failure	26.3	18.8	< 0.0001
Solid tumor without metastasis	2.6	2.7	0.5900
Peptic ulcer disease excluding bleeding	0.0	0.1	< 0.0001
Valvular disease	5.2	4.7	0.0100
Weight loss	39.1	40.9	< 0.0001