FACTORS INFLUENCING LENGTH OF HOSPITAL STAY AND HOSPITAL CHARGES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A FIVE-YEAR POPULATION BASED STUDY
BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the gastrointestinal tract. The remitting and relapsing condition of patients with IBD requires long term therapy and periodic inpatient management. However, there is paucity of literature regarding factors having an effect on in-patient mortality and length of stay (LOS) in the hospital among patients with IBD. Hence, the objective of this study is to determine factors associated with prolongation of hospital stay in this population.
METHODS: We conducted a five-year retrospective analysis and estimated the national inflammatory bowel disease related hospitalization from 2009 to 2013 in the United States, using the Healthcare Cost and Utilization Project National Inpatient Survey Database. The main outcome measures were IBD-associated hospitalizations (ICD-9 codes 555.X and 556.X), length of stay, and total hospital charges. A univariate and multivariable analyses of length of hospital stay and total hospital charges were performed while controlling for potentially confounding variables including age, sex, primary payer, hospital type (teaching or non-teaching), hospital size and hospital location (urban or rural), co-infection with Clostridium difficile. We computed the variance estimates accounting for finite population correction (fpc) factor.
RESULTS: A total of 295,296 IBD related hospitalizations occurred between 2009 and 2013. Sixty-four percent of the cases were ulcerative colitis (UC) and 36% had diagnosis of Crohn’s disease (CD). The majority of IBD hospitalizations were elderly patients ages greater than 60 years (37%), females (57%) and Caucasians (80%). Sixty-nine percent of the admission types were through emergency department and about 90% of the admissions occurred in urban hospital locations. The median LOS was 3 days (interquartile (IQR) range, 2-6 days) and median hospital charge per patient was $23, 663 (IQR, $13,143-44587). Results from the multivariate analysis showed that – Longer LOSs were significantly associated with CD patients compared to those with UC, elderly patients and males compared with females, teaching hospitals compared to non-teaching hospital and urban hospital locations than rural locations (p-values < 0.001). Blacks and Hispanics patients had significantly shorter hospital stay than White (p-values < 0.05). Similarly, there were significantly shorter LOS in those without C. difficile infection compared with having C-difficile infection, and those with private insurance or self-pay compared with having Medicare coverage (p-values < 0.001). Total charges were significantly higher for CD hospitalization compared to UC, other forms of payment (self-pay, private insurance, Medicaid) compared to Medicare coverage, and urban hospital location than rural hospitals (p-values < 0.001).
DISCUSSION: Limited data exists regarding factors affecting hospital stay in IBD patients hence further studies are required to investigate into other potential factors since addressing those factors may reduce hospitalizations and healthcare costs. Increased vigilance to prevent Clostridium difficile infection among patients with IBD could improve outcomes as well.