Rising Us Hospital Admissions for Gram+ Acute Bacterial Skin and Skin Structure Infections (Absssi)

Background:

In an era of healthcare reform, an important priority to reduce costs and produce savings is to decrease and avoid hospital stay since hospital admissions account for a large proportion of healthcare spending. Our objective was to characterize the recent trends and predictors of hospital costs for ABSSSI admissions in the US.

Methods:

A retrospective cross‐sectional database analysis was performed using the largest publicly available all‐payer inpatient database, US Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), representing >1,000 hospitals with more than 8 million hospital stays per year, from 2005 to 2011. The analysis included adult (≥18 years) hospital admissions with a principal diagnosis of ABSSSI: 681.XX, 682.XX, 686.XX, 958.3, 998.5X, and 035. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. Data were weighted using a “weight” variable provided by HCUP, to produce national estimates. Costs were inflated to 2012 USD.

Results:

There were 4,891,187 adult ABSSSI hospital admissions representing roughly 2% of all hospital admissions from 2005 to 2011. Hospital admissions were predominantly in urban hospitals (85.4%) of large bed size (325 to >450 beds by region, 59.1%). ABSSSI patients were often white (60.3%) with mean age 55.7 years (±18.6 yrs), with Medicare insurance coverage (40.7%), moderate severity of illness and low risk of mortality at baseline. ABSSSI hospital admissions significantly increased over time by 17.3% from 2005 to 2011 (641,863 to 752,770 respectively, p<0.0001), while LOS significantly decreased over this time period (5.40 to 4.95 days, p<0.0001). The average total cost of an ABSSSI admission was $9,895 in 2011, with earlier years being > $10,000. Adjusted costs were greater in patients with post‐operative wound infections ($9,388) compared to other ABSSSI diagnoses ($7,222 to $7,898). Adjusted healthcare costs nearly doubled when LOS increased to 3‐6 days as compared to <3 days ($8,365 vs $4,820, respectively). APR‐DRG severity of illness/mortality risk and type of infection were the common strongest predictors of mortality, LOS and costs, in addition to year of admission (for mortality), discharge disposition (for LOS), and LOS (for costs).

Conclusions:

Nationally, ABSSSI related hospital admissions have increased in the recent years, while hospital LOS has significantly decreased by almost half a day which may indicate that more patients are being shifted to outpatient settings for some of their care.