Healthcare Utilization Among Patients Hospitalized With Gastrointestinal Diseases in the United States
Kush Fansiwala1, Neha Rajpal2, Shaya Noorian1
1Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Insights
Gastrointestinal (GI) disorders significantly increase hospital readmissions, length of stay, and costs compared to non-GI conditions. Cancers and gastroparesis represent major drivers of this healthcare burden.
Area of Science:
- Gastroenterology and Hepatology
- Health Services Research
- Oncology
Background:
- Gastrointestinal (GI) disorders pose a substantial healthcare burden in the US.
- Limited research quantifies the specific impact of individual GI conditions on healthcare utilization.
Purpose of the Study:
- To determine the relative impact of various GI conditions versus non-GI conditions on US hospital-related healthcare utilization.
Main Methods:
- Analysis of Nationwide Readmissions Database data from 2016-2018.
- Inclusion of over 5.3 million patients with GI indications and 68.9 million with non-GI indications.
- Multivariable regression models assessed length of stay, hospital charges, 30-day readmissions, and death, adjusting for patient and hospital factors.
Main Results:
- All GI indications were linked to higher odds of 30-day readmission compared to non-GI conditions, with gastroparesis showing the highest odds (aOR 2.15).
- Upper GI cancer led to the greatest increase in length of stay (2.31 days) and total charges ($23,441).
- Upper GI cancer, pancreatic cancer, and gallbladder/biliary cancer were associated with the highest mortality risk.
Conclusions:
- GI malignancies significantly contribute to healthcare utilization and mortality, potentially due to advanced disease at presentation.
- High GI-specific readmission rates underscore the chronic nature of these conditions and the need for improved digestive health management to reduce hospital admissions.
Background And Aims:
Gastrointestinal (GI) disorders represent a significant burden on United States healthcare, but research assessing the relative contribution of individual GI disorders is lacking. We aimed to determine the relative impact of various GI conditions, as compared to non-GI conditions, on US hospital-related healthcare utilization.
Methods:
Hospitalization data from 2016 to 2018 were obtained from the Nationwide Readmissions Database. Outcomes included length of stay, hospital charges, 30-day readmissions, and death. Multivariable regression models evaluated each outcome, while adjusting for patient and hospital characteristics. Patients hospitalized for each GI indication were compared to individuals hospitalized for non-GI conditions.
Results:
5,344,145 patients with GI and 68,901,595 patients with non-GI indications for hospitalization were included in our study. All GI indications were associated with increased odds for 30-day readmission compared to non-GI indications, with the highest being gastroparesis (adjusted odds ratio, 2.15; 95% confidence interval [CI], 2.09-2.22). Upper GI cancer had the highest relative increase in length of stay (2.31 days, 95% CI 2.20-2.42) and total charges ($23,441, 95% CI $21,296-25,587). Upper GI cancer, pancreatic cancer, and gallbladder/biliary cancer were associated with the highest odds of death.
Conclusion:
GI malignancies contributed significantly to utilization and death, possibly from advanced stage at hospitalization and systemic effects of malignancy. The high GI-specific readmission rates highlight the chronicity of GI conditions and the importance of optimizing digestive health to prevent recurrent admission.
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