Title : Mortality, length of stay, and cost of hospitalization among adult patients with multiple sclerosis: results from the National Inpatient Sample.
Abstract:
Introduction: The study was performed to evaluate factors associated with in-hospital mortality, length of stay (LOS), and hospitalization cost among adults with multiple sclerosis (MS).
Methods. We used the National Inpatient Sample (2019) to identify adult hospitalizations with MS. Logistic, Poisson, and linear regression models were constructed to evaluate mortality, LOS and log transformed cost of hospitalization respectively. Dynamite plot was added to determine the most common primary diagnoses among the entire cohort and non-survivors.
Results. There were 151,635 hospitalizations with MS nationwide, and the inpatient mortality rate was 1,58%. Non-survivors were predominantly older (median age 66.0 years, IQR (Interquartile range) 57.75-74.00), female (68%) and Caucasian (81.6%).
Using clinical classification software diagnostic categories, bacterial infections (12%) and septicemia (11%) were the most common primary diagnostic groups among the entire cohort and among those who died (28% each). Respiratory failure (adjusted odds ratio (aOR) = 10.8, 95%CI (confidence interval): 8.4-13.9, p=0.001) was strongly associated with in-hospital mortality. Diabetes Mellitus (aOR = 0.6, 95%CI: 0.4-0.8, p=0.001) was associated with decreased in-hospital mortality, although univariate model failed to find such association (OR = 0.95, 95% CI:0.76-1.18, p=0.62).
Median length of stay was 4 days (IQR 2-6), while the median cost of hospitalization was $36,844 (IQR $20,871-$66,480). Patients with Asian race had the highest cost of hospitalization (median $53,005, IQR $27,749-$93,653, p=0.001). Multivariable linear regression with log transformed hospitalization charge re-affirmed that Asian race was associated with higher hospitalization cost (adjusted regression coefficient (β) = 0.192, 95%CI: 0.087-0.297, p=0.001), as well as private insurance (adjusted β=0.041, 95%CI: 0.017-0.165, p=0.001). Patient-level factors associated with higher hospitalization costs were stroke and transient ischemic attack (adjusted β=0.224, 95%CI: 0.172-0.276, p=0.001), and respiratory failure (adjusted β=0.273, 95%CI: 0.242-0.304, p=0.001).
In a restricted cohort, multivariable Poisson regression model showed that Black race was associated with longer LOS (adjusted incidence rate ratio (aIRR)=1.043, 95%CI: 1.02-1.067, p =0.001), while private insurance was associated with shorter LOS (aIRR=0.952, 95%CI: 0.932-0.972, p=0.001). Clinical factors associated with longer LOS were pressure ulcer (aIRR=1.229, 95%CI: 1.201-1.257, p=0.001) and respiratory failure (aIRR=1.224, 95%CI: 1.195-1.254, p=0.001).
Conclusion. Bacterial infections and septicemia were the most common primary diagnoses among adults hospitalized with multiple sclerosis. Bacterial infections, followed by septicemia were top two primary diagnoses for non-survivors. Respiratory failure was strongly associated with in hospital mortality.
What will audience learn from your presentation?
- Bacterial infections are the most common diagnoses among adults admitted to the hospital with a history of multiple sclerosis.
- Respiratory failure was strongly associated with in-hospital mortality.
- It may be possible that intervention targeting early recognition or optimal management of infections may lead to improved outcomes.
• How will this help the audience in their job? Is this research that other faculty could use to expand their research or teaching? Does this provide a practical solution to a problem that could simplify or make a designer’s job more efficient? Will it improve the accuracy of a design, or provide new information to assist in a design problem? List all other benefits.
-Study lists contemporary epidemiology and patient outcomes of patients with multiple sclerosis who have been admitted to the US hospitals.
- The study is observational and should be served as hypothesis generating. Our work doesn't provide a “practical solution” to the problem of reduction of mortality, length of stay (LOS), or hospitalization costs. The primary aim of the study was to describe the relationship between pre-selected outcome variables such as mortality, LOS, and charges and a group of dependent variables.
