Regional Variation in Resources Utilization and Outcomes Following Out-of-Hospital Cardiac Arrest in the United States

Background:

Regional differences in health care strategies, resource utilization and outcomes following Out-of-Hospital Cardiac arrest are not well studied. These differences may have significant implications on optimizing health care delivery and allocating expensive resources.

Methods:

We used the 2002 to 2012 Nationwide Inpatient Sample database to identify adults ≥ 18 years old, with an ICD-9 code principal diagnosis of cardio respiratory arrest (427.5) or ventricular fibrillation (427.41). Trauma patients were excluded. In 4 predefined federal geographic regions: North East, Midwest, South and West,  means and proportions of total hospital charges (adjusted to the 2012 consumer price index,) length of hospital stay (LOHS) and mortality rate were calculated. Multiple linear and logistic regression models, were adjusted for patient demographics, hospital characteristics and Charlson Comorbidity Index. Trends in binary outcome were examined with Year×Region interaction terms.

Results:

From 2002 to 2012, of 155,592 OHCA patients who survived to hospital admission, 26,007 (16.7%) were in the Northeast, 39,921 (25.7%) in the Midwest, 56,263 (36.2%) in the South, and 33,401 (21.5%) in the West. Total hospital charges (THC) rose significantly over the years across all regions of the United States (P trend <0.0001), and were higher in the West Vs the North East (THC>$109,000/admission, AOR 1.85; 95% CI 1.53-2.24, p<0.0001), and not different in other regions. Compared to the Northeast, mortality was lower in the Midwest (AOR 0.86, 95% CI 0.77-0.97 p=0.01), marginally lower in the South (AOR 0.91, 95% CI 0.82-1.01 p=0.07), with no difference detected between the West and the Northeast (AOR 1.02, 95% CI 0.90-1.16 P=0.78). Increased expenditure was not rewarded by an increase in survival, as trends in Mortality did not differ significantly between regions (Year×Region effects P>0.05, P trend =0.29). Prolonged LOHS (>8 days/admission) was significantly less likely in the South (AOR 0.89, 95% CI 0.80-0.99 P=0.04) and the West (AOR 0.88, 95% CI 0.78-0.99 P=0.04) compared to the Northeast, even after adjustment for key covariates. 

Conclusions:

There is a significant regional variability in survival, hospital charges and length of hospital stay in Out-of-hospital cardiac arrest patients in the United States. Further investigations are needed to identify factors that drive such differences and optimize health care delivery.