Sepsis rehabilitation in Japan surged and started earlier over a decade, nationwide study finds

Between 2010 and 2020, the share of sepsis hospitalizations in Japan that included inpatient rehabilitation more than doubled, rising from 25.2 percent to 68.2 percent, according to a nationwide cohort study published in BMC Health Services Research by the Japan Sepsis Alliance (JaSA) study group. The study identified adults aged 18 years or older hospitalized with sepsis using criteria for presumed serious infection combined with acute organ dysfunction. Of the 4,426,342 sepsis hospitalizations captured between 2010 and 2020, 2,251,329, or 50.9 percent, involved rehabilitation.

Hospitalizations that included rehabilitation were characterized by older patient age and more frequent use of intensive care treatments, including mechanical ventilation, vasoactive drugs, and renal replacement therapy, suggesting that rehabilitation was increasingly delivered even to the most severely ill patients. The researchers evaluated temporal trends using Cochran-Armitage trend tests, linear regression analyses, and multivariable modified Poisson regression analyses adjusted for patient characteristics, comorbidity burden, and indicators of treatment intensity. The rise in rehabilitation implementation remained statistically significant after these adjustments, indicating that the trend was not explained simply by changes in the case mix of sepsis patients, such as aging or greater use of intensive care.

The timing and structure of rehabilitation delivery shifted markedly over the decade. The median time from hospitalization to the start of rehabilitation fell from 8 days in 2010 to 4 days in 2020. The median duration of rehabilitation decreased from 18 days to 13 days, while the proportion of the hospital stay spent receiving rehabilitation rose from 41.7 percent to 51.0 percent.

Taken together, these figures suggest that rehabilitation was initiated sooner after admission and woven more densely into the hospitalization itself, even as overall rehabilitation courses became somewhat shorter. Notably, the authors report that these temporal patterns were consistent regardless of survival status. In other words, the expansion and acceleration of rehabilitation services were observed both among patients who survived their hospitalization and among those who did not, rather than being confined to a narrowly defined group of recovering patients.

Subgroup analyses added further texture to the national picture. Rehabilitation implementation rates were higher among hospitalizations involving older individuals, admission to an intensive care unit, or septic shock. Hospitalizations involving ICU admission or septic shock also had longer rehabilitation durations.

Rehabilitation has been increasingly recognized as an essential component of recovery for patients with sepsis, yet, as the authors note, the real-world delivery of rehabilitation services for sepsis had not previously been characterized at a national level. The authors caution that the study is retrospective and observational, relying on administrative claims data, so it describes patterns of service use rather than the effects of rehabilitation on patient outcomes. The findings therefore characterize delivery, not efficacy, and the study group frames them as evidence that may inform healthcare planning and resource allocation for recovery-oriented care rather than as proof of clinical benefit.

Even with those limitations, the scale of the change is striking. In a single decade, inpatient rehabilitation went from a minority practice among sepsis hospitalizations in Japan to something delivered to roughly two out of three patients, started in about half the previous time, and covering more than half of the typical hospital stay.

Subject of Research: National trends in inpatient rehabilitation utilization among sepsis patients in Japan from 2010 to 2020

Article Title: National trends in inpatient rehabilitation utilization among patients with sepsis in Japan: a nationwide cohort study from 2010 to 2020 by the Japan Sepsis Alliance (JaSA) study group

Article References: Imaeda, T., Kawamura, Y., Oami, T., Yokoyama, T., Nakagawa, S., Ogura, H., Shime, N., Umemura, Y., Matsushima, A., Fushimi, K., & Nakada, T.-A. (2026). National trends in inpatient rehabilitation utilization among patients with sepsis in Japan: a nationwide cohort study from 2010 to 2020 by the Japan Sepsis Alliance (JaSA) study group. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15464-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15464-4

Keywords: sepsis, inpatient rehabilitation, Japan, nationwide cohort study, Diagnosis Procedure Combination database, intensive care unit, septic shock, post-intensive care syndrome, health services research, recovery-oriented care, temporal trends, National