Tamta Chkhikvadze, MD1, Nino Gigauri, MD2, Lasha Gogokhia, MD3, Junxin Shi, MD, PhD4, Ye Eun Kwak, MD5
1New York University Langone Health, New York University School of Medicine, Brooklyn, NY; 2Saint Francis Hospital and Medical Center, Hartford, CT; 3Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY; 4The Research Institute at Nationwide Children’s Hospital, Columbus, OH; 5The University of Chicago Medicine, Chicago, IL
Introduction: Enterocolitis due to Clostridium Difficile infection (CDI) has been a leading and drastically rising cause of nosocomial infection worldwide. We aimed to examine the trends, demographics and hospital resource utilization of CDI hospitalizations in the United States using the largest available national administrative database.
Methods: We analyzed National Inpatient Sample (NIS) database from 2005 to 2016. We extracted patient discharge data using ICD-9 (008.45) and ICD-10 (A04.7) primary diagnoses codes for enterocolitis due to CDI from 2005 to 2014 and 2016, respectively. Combined ICD-9 and ICD-10 diagnoses codes were used for year 2015 due to coding transition. Trend in hospitalization due to enterocolitis from CDI was the primary outcome. Secondary outcomes included inpatient mortality, mean hospital charges, hospital length of stay (LOS) and demographic disparities. Type of hospitals and discharge places for CDI were also analyzed.
Results: Total of 257,613 CDI enterocolitis admissions were identified from 2005-2016, which is estimated to 1,255,271 hospitalizations nationally. Increasing trends in CDI admissions were noted from 73,611 in 2005 to 106,245 in 2016 (Figure 1). In-hospital mortality demonstrated decreasing trend from 4% in 2005 to 1.3% in 2016. Female represented majority of CDI admissions throughout the entire examined years (65% female vs. 35% male). There was significant racial disparity in CDI admissions, with 77.3% white, 10.5% black, 8.3% Hispanic, 1.3% Asian/Pacific Islander and 2.6% Native American origin. Admissions to teaching hospitals due to CDI showed increasing trend from 37% in 2005 to 60% in 2016, whereas admissions to non-teaching hospitals decreased from 63% in 2005 to 40% in 2016. Mean charges have increased by 8.4% from $34,887 to $37,832 (table 1), while mean LOS has decreased by 1.6 days, corresponding to -22% change from 2005 to 2016 (table 2). Most patients were discharged home (59%), while others were discharged to home health care (16%), long-term care facilities (22%) or short term care facilities (1%).
Discussion: CDI related admissions and mean hospital charges have been increased nationally from 2005 to 2016, despite the decrease in length of stay and in-hospital mortality. Significant racial disparities in CDI admissions persisted throughout the decade. Further research investigating preventive measures to decrease hospitalization and cost as well as to improve racial disparities and resource utilization for CDI is needed.
Citation: Tamta Chkhikvadze, MD; Nino Gigauri, MD; Lasha Gogokhia, MD; Junxin Shi, MD, PhD; Ye Eun Kwak, MD. P1042 - THE LATEST TREND AND DISPARITIES IN CLOSTRIDIUM DIFFICILE COLITIS RELATED HOSPITALIZATIONS IN THE UNITED STATES. Program No. P1042. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.