Hospitalizations for Severe Sepsis in California
In 2024, over 300,000 severe sepsis patients were treated in California hospitals. About 13%, over 42,000, of those died in hospital. Hospital charges for sepsis totaled $95 billion in California, based on total charges for all sepsis.
Why Hospitalizations for Severe Sepsis?
Sepsis is a preventable, life-threatening medical condition, which if not treated timely and properly, can result in a severe condition with multiple organ failure (severe sepsis) and death. Sepsis impacts approximately 1.7 million people annually in the United States. Hospitalizations for sepsis are among the most expensive (CDC: What is Sepsis?).
The Patient Information tab presents patient data on in-hospital and 30-day mortality, length of stay, charges, and expected payers for severe sepsis hospitalizations. The Hospital Information tab presents hospital characteristics including hospital size, location, ownership, and designation as a teaching facility.
Key Findings
Findings About Patients
- From 2017 to 2024, severe sepsis cases rose by 43%, while deaths increased by 15%, lowering the in-hospital mortality from 16% to 13%. Mortality peaked at 19% in 2021 and has decreased each year since, reaching its lowest point in 2023 and 2024.
- Among severe sepsis patients, 8.6% had a diagnosis of COVID-19 in 2024 compared with 11.0% in 2023. Among severe sepsis patients who died in the hospital, 7.5% had a COVID-19 diagnosis in 2024 compared with 10.6% in 2023.
- From 2017 to 2024, severe sepsis cases rose by 43%, while deaths increased by 15%, lowering the in-hospital mortality from 16% to 13%. Mortality peaked at 19% in 2021 and has decreased each year since, reaching its lowest point in 2023 and 2024.
- Non-hospital-acquired severe sepsis cases outnumbered hospital-acquired cases from 2017 to 2024. There was a 44.9% increase for non-hospital acquired severe sepsis cases and a 16.5% increase in hospital-acquired cases.
- From 2017 to 2024, the average length of stay for severe sepsis decreased from 9.9 days to 9.3 days. The median charge per day increased by 38.5% in the same period (charges may not reflect the actual cost paid by the patient or insurer).
- Medicare was the expected payer for more hospitalized severe sepsis cases than any other payer in 2024, accounting for 207,118 hospitalizations (61.1%), followed by Medi-Cal for 75,038 hospitalizations (22.1%), Private Health Insurance for 45,793 hospitalizations (13.5%), Other Government for 5,603 hospitalizations (1.7%), Self Pay Or Uninsured for 3,071 hospitalizations (0.9%) and All Other Payers for 2,369 hospitalizations (0.7%).
- In 2023, most severe sepsis patients who died within 30 days following discharge died at hospice care facilities (50.9%), followed by skilled nursing facilities (22.1%), and home health service organizations (10.8%).
- The percentage of hospital-acquired severe sepsis patients among those who died within 30 days of discharge increased from 8% to 8.3% from 2017 to 2023, while the share who acquired severe sepsis outside the hospital decreased.
Findings About Hospitals
- The smallest hospitals (1-99 beds) had the highest rates of hospital-acquired severe sepsis.
- Urban hospitals had higher rates of hospital-acquired severe sepsis compared to rural hospitals. But, from 2017 to 2024, the rates of hospital-acquired severe sepsis increased by 48% for rural hospitals and 19% for urban hospitals.
- Nonprofit hospitals had the lowest rates of hospital-acquired severe sepsis, followed by investor-owned hospitals and governmental hospitals. From 2021 to 2024, the rates of hospital-acquired severe sepsis decreased in all three categories.
- Teaching hospitals had higher rates of hospital-acquired severe sepsis compared to non-teaching hospitals.
Visualization
1 Hospitalization charges reported as $0 are not included. Charges are not adjusted for inflation.
2 Investor-owned hospitals are for-profit. Nonprofit hospitals are operated by nonprofit organizations such as churches. Governmental include district, city/county and state facilities that receive government funding.
Note:
- HCAI has updated its definition of severe sepsis to include additional diagnosis codes over years. As a result, users should interpret the increase in severe sepsis cases with caution, as part of the observed rise may be attributed to this change in definition.
- Missing or invalid funding source was excluded from the analysis.
Glossary
Expected Payer: The payer type that was expected to pay the greatest share of the patient’s bill at the time of discharge, not the payer type that actually paid.
| Payer Groupings | Inpatient Discharges |
|---|---|
| Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Medicare Advantage and Medicare Fee-for-Service (Traditional Medicare). | Medicare Advantage, traditional Medicare |
| Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Managed Care and Medi-Cal Fee-for-Service. | Medi-Cal managed care, fee-for-service Medi-Cal |
| Private Health Insurance: Coverage by private, non-profit or commercial health plans or through organizations. Includes individual coverage purchased through Covered California, and organized charity payers (e.g., March of Dimes, Shriners). | Private Coverage |
| Other Government: Public insurance programs other than Medicare or Medi-Cal, including federal, state, county and veteran-specific programs. | County Indigent, Other Government |
| Self-Pay or Uninsured: Coverage where the greatest share of the patient’s bill is not expected to be paid by any other form of insurance or health plan. Includes uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private. | Other Indigent, Self-Pay |
| All Other Payers: Includes payers not categorized elsewhere: Workers’ Compensation, third-party payment not included in any other category, stays for which no payment will be required by the facility (e.g. courtesy patients), stays for which no valid expected payer was reported to HCAI | Workers’ Compensation, Other Payer |
General Information about Sepsis
- Sepsis: the body’s extreme response to an infection. Almost any type of infection can lead to sepsis.
- Sepsis symptoms: high heart rate or low blood pressure, chills, fever, extreme pain or discomfort, confusion, shortness of breath or clammy/sweaty skin.
- Hospital-acquired sepsis: acquired while a patient is hospitalized for another illness or procedure.
- Severe sepsis: without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
- People in high-risk of developing sepsis: the very young, the very old, those with chronic illnesses, and those with a weakened or impaired immune system.
- For more information on sepsis, visit the Centers for Disease Control and Prevention website.
How HCAI Created This Product
Severe sepsis cases were identified by a diagnosis of sepsis and organ dysfunction from the Patient Discharge Data (PDD). To protect patient personal information, the California Health and Human Services Agency has adopted a policy of statistically masking or de-identifying sensitive data (CalHHS Data De-Identification Guidelines).
Urban and Rural designations are determined based on the Medical Service Study Area Designation (MSSA) framework. MSSAs were developed using combinations of census-defined geographic units, established following General Rules issued by a statutory commission. An MSSA is designated as “Rural” if it has a population density of fewer than 250 persons per square mile and contains no census-defined place with a population exceeding 50,000. All other MSSAs are classified as “Urban.”
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Inpatient Discharges
Citation: HCAI – Patient Discharge Data, California Inpatient Severe Sepsis, 2017-2024
Temporal Coverage: 2017-2024
Spatial/Geographic Coverage: Statewide
Frequency: Annually