Davis Berry, DO
Columbia, South Carolina
Davis B. Berry, DO1, Marwan S. Abougergi, MD2, Ahmad Khan, MD3, Kamesh Gupta, MBBS4
1Prisma Health, Columbia, SC; 2Catalyst Medical Consulting, Simpsonville, SC; 3West virginia University Health Sciences Center, Charleston, WV; 4University of Massachusetts Medical School - Baystate Medical Center, Springfield, MA
Introduction: The efficiency and delivery of care has been at the center of the current healthcare debate and reform. Clostridium Difficile Infection (CDI) is the leading cause of hospital acquired infectious diarrhea. This study sought to investigate the effect of hospital size, urban location and teaching status on in-hospital mortality and resource utilization among patients admitted to hospital with CDI.
Methods: This is a retrospective cohort study using the National Inpatient Sample (NIS) 2016. NIS is the largest publicly available all-payer inpatient care database in the United States. Patients were included if they had a principal diagnosis of CDI, and were excluded if they were younger than 18 years. The primary outcome was in-hospital mortality. The secondary outcome was resource utilization as measured by hospital length of stay (LOS) and total hospitalization charges. The exposure of interest was hospital size, urban location and teaching status. Multivariate regression analysis was utilized to account for confounders.
Results: 19,580 patients were included in this study. The mean age was 64 years and 64% of patients were females. Adjusted odds ratios (aOR) and mean differences (aMD) are presented in Table 1. After adjusting for confounders, the odds of in-hospital mortality were similar for patients at rural, urban teaching and urban non-teaching hospitals as well as at small, medium and large hospitals. However, patients treated at urban teaching and non-teaching hospitals had significantly longer LOS compared with those treated at rural hospitals. Similarly, patients treated at large and medium hospitals had significantly longer mean LOS compared with those treated at small hospitals. Patients treated at urban teaching and non-teaching hospitals had significantly higher mean total hospitalization charges compared with those treated at rural hospitals, and patients treated at large and medium hospitals had significantly higher mean total hospitalization charges compared with those treated at small hospitals.
Discussion: Despite significantly higher resource utilization (LOS and total hospitalization charges) at larger urban teaching hospitals, CDI in-hospital mortality was similar to those treated at small, rural non-teaching hospitals. One possible explanation lies in the complexity of CDI larger teaching referral centers. Another possibility is the variable adherence to C. difficile infection guidelines.
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Citation: Davis B. Berry, DO; Marwan S. Abougergi, MD; Ahmad Khan, MD; Kamesh Gupta, MBBS. P1939 - IMPACT OF HOSPITAL SIZE AND TEACHING STATUS ON PATIENTS WITH CLOSTRIDIUM DIFFICILE COLITIS TREATMENT OUTCOMES. Program No. P1939. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.