Heather Peluso, DO1, Wesley B Jones, MD1, Marwan S Abougergi, MD2. 1Greenville Health System, 2Catalyst Medical Consulting, LLC
Introduction: We sought to determine the impact of day of admission on treatment outcomes and resource utilization among patients with necrotizing fasciitis in the United States.
Methods: This is a retrospective cohort study using the 2014 National Inpatient Sample. Discharges were included if they had a principal diagnosis of necrotizing fasciitis. Patients <18 years and non-urgent admissions were excluded. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (sepsis and prolonged mechanical ventilation (PMV)), treatment metrics (time to surgery) and resource utilization (length of stay (LOS) and total hospitalization costs and charges). The following confounders were adjusted for using multivariate regression analysis: patient’s sex, age, race, Charlson comorbidity index, median income in patient’s zip code, hospital urban location, region, teaching status and bedsize.
Results: 3,590 patients were included in the study, 24% of whom were admitted on weekends. The mean age was 53 (52 – 54) years and 42% were Female. Weekend admission was not a predictor of mortality (adjusted odds ratio (aOR):1.29 (0.38-4.33), p=0.68). Rates of septic shock (aOR:1.03 (0.51-2.08), p=0.93) and PMV (aOR: 0.87, (0.39-1.95), p=0.74) were similar for both groups. Time to surgery (adjusted mean difference (amDiff):1.15 (0.77-1.71) days, p=0.50) was similar for patients admitted on weekdays and weekends. Furthermore, LOS (amDiff:-1.77 (-4.04-0.50) days, p=0.13), total hospitalization costs ($-4,788 ($-11,833-$2,256), p=0.18), and charges (amDiff:$-15,276 ($-44,906-$14,353), p=0.31) were also similar for both groups.
Conclusion: In-hospital mortality, morbidity, treatment metrics, and resource utilization were not different between patients admitted on weekends and on weekdays. Therefore, day of admission does not affect treatment outcomes or resource utilization among patients with necrotizing fasciitis.
Table 1: Primary and Secondary Outcomes
|
|
Adjusted Odds ratio (95% confidence interval) |
P value |
|
In-hospital mortality |
1.29 (0.38-4.33) | 0.65 |
| Morbidity | ||
| Septic Shock | 1.03 (0.51-2.08) | 0.93 |
| PMV | 0.87 (0.39-1.95) | 0.74 |
|
Adjusted Mean Difference * (95% confidence interval) |
||
| Treatment metrics | ||
| Time from admission to surgery | 1.15 (0.77-1.71) days | 0.50 |
| Resource Utilization | ||
| LOS | -1.77 (-4.04-0.50) days | 0.13 |
| Total costs | $-4,788 ($-11,833-$2,256) | 0.18 |
| Total charges | $-15,276 ($-44,906-$14,353) | 0.31 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94214
Program Number: P026
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster