Davis Berry, DO
Columbia, South Carolina
Davis B. Berry, DO1, Marwan S. Abougergi, MD2
1Prisma Health, Columbia, SC; 2Catalyst Medical Consulting, Simpsonville, SC
Introduction: Treatment outcomes for many medical and surgical conditions have been shown to vary significantly between the different regions of the United States. This study was aimed to determine the regional differences in in-hospital mortality and resource utilization among patients admitted to the hospital with Clostridium Difficile infection (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 Northeast, Midwest, South and West regions were compared. Multivariate regression analysis was utilized to account for confounders.
Results: 19,580 patients were included in the 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. The odds of in-hospital mortality were significantly lower among patients treated in the Midwest compared with the Northeast, West and South (aOR: 0.66, 95% confidence interval (CI): 0.45-0.99, p=0.04). In addition, patients treated in the Midwest (aMD: - 0.74 days , CI: -1- - 0.48 days, p< 0.01) and West (aMD: - 0.40 days , CI: - 0.67 - 0.12 days, p< 0.01) had significantly shorter mean length of stay compared with those in the Northeast and South. Finally, compared with patients treated in the Northeast, those treated in the Midwest and South had significantly lower mean total hospitalization charges (aMD -$12,693, CI: -$16,075 - -$9,312, p< 0.01 and -$5,647, CI: -$9,074 - -$2,220, p< 0.01, respectively) while those treated in the West had significantly higher mean total hospitalization charges (aMD: $9,796, CI: $5,186 - $14,406).
Discussion: Among patients hospitalized with CDI, in-hospital mortality and resource utilization (LOS and total hospitalization charges) vary significantly across the four United States regions. The lowest mortality rates and resource utilization are in the Midwest. Complex socioeconomic variables likely explain this variation, along with possible variable physician adherence to treatment guidelines. Further research is needed to elucidate this point.
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Citation: Davis B. Berry, DO; Marwan S. Abougergi, MD. P1938 - REGIONAL VARIATION IN TREATMENT OUTCOMES IN CLOSTRIDIUM DIFFICILE COLITIS: A NATIONWIDE ANALYSIS. Program No. P1938. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.