Changes in Sepsis Hospitalizations and Mortality After Junior Physicians’ Walkout in the Republic of Korea: A Nationwide Interrupted Time-Series Study

Background: The junior physicians' walkout in Republic of Korea (= South Korea) persisted for an unusually prolonged period, raising concerns regarding its potential adverse effect on public health.We evaluated the national-level effects of the junior physicians' walkout on sepsis-related admissions and clinical outcomes in Korea.Methods: A nationwide natural experiment was conducted using data from the National Health Insurance Service database to assess the effect of the walkout on sepsis care and outcomes.Sepsis cases were identified using diagnostic codes.Changes in sepsis admissions and in-hospital mortality before and after the walkout were evaluated using interrupted timeseries analysis.Results: A total of 136,844 patients with sepsis were identified, including 68,749 in the pre-walkout period and 68,095 in the post-walkout period.The proportion of patients treated at tertiary hospitals decreased from 29.7% to 22.5%, whereas the proportion treated at general hospitals increased from 46.2% to 51.5%.Overall in-hospital mortality did not differ significantly between the two periods, with rates of 19.2% and 18.6% in the pre-and post-walkout period, respectively.A significant decrease in sepsis admissions was observed immediately after the walkout, largely driven by reductions in admissions to tertiary hospitals.The post-walkout trend demonstrated a gradual increase in sepsis admissions over time.Although no significant change in mortality was observed in the overall cohort, a significant reduction in in-hospital mortality was noted among patients treated at general hospitals after the walkout.Conclusion: Sepsis-related healthcare utilization patterns changed during the junior physicians' walkout in Korea; however, no significant increase in overall mortality was observed.These findings suggest that general and secondary hospitals may have absorbed increased demand for sepsis care despite workforce shortages.