S5 Characteristics and Outcomes of Patients With IBD Admitted to High vs Low Safety Net Burden Hospitals: A Nationwide Analysis

Introduction: Inflammatory bowel disease (IBD), is a chronic relapsing inflammatory disorder that requires a meticulous multidisciplinary management approach. This may prove difficult in safety net hospitals, and it is unclear if a hospital’s safety net burden (SNB) is associated with outcomes. The aim of this study was to investigate the effect of hospital SNB on in-hospital mortality, length of stay, and hospitalization cost in patients with IBD. Methods: We used the National Inpatient Sample (NIS) to identify all adult hospitalizations with IBD from 2016 to 2018. SNB was calculated as the percentage of hospitalizations with Medicaid or uninsured payer status for each hospital in the 2016-2018 database. Multivariable models were used to compare outcomes of admissions to hospitals with low SNB (lowest tertile, < 18.1%) hospitals with high SNB (highest tertile, >31.1%). Results: The demographic and clinical characteristics for the 106,603 patients hospitalized with IBD are shown in Table. Of all patients, 42.3% were admitted to low SNB hospitals and 57.7% were admitted to high SNB hospitals. The main study outcomes (in-hospital mortality, length of stay, and cost) are also shown in Table. In-hospital mortality was 1.4% in low SNB hospitals and 1.6% in high SNB hospitals (adjusted OR=1.15, 95% CI 1.03-1.29, p=0.016). Mean length of stay was longer in high SNB hospitals compared to low SNB hospitals (5.6 vs 5.1 days, adjusted mean difference 0.38 days, p< 0.0001). Low SNB hospitals had higher hospitalization costs compared to high SNB hospitals ($15,968 vs $15,670, adjusted mean difference $402, p=0.01). Conclusion: In this large population of inpatients with IBD, patients admitted to high SNB hospitals had overall worse hospital mortality and longer length of stay. Patients admitted to low SNB hospitals had higher hospital costs. Further research is needed to clarify the cause of these discrepant outcomes in IBD hospitalizations, and specific interventions are needed to improve the delivery of care to IBD patients in high SNB hospitals. Table 1. - Demographic, clinical, and hospital characteristics and outcomes of admissions with inflammatory bowel disease (n=106,603) stratified by safety net burden (SNB), National Inpatient Sample database, 2016-2018 Low SNBN=45,144 High SNBN=61,459 Patient Characteristics Age, mean (SD), y 55.9 (19.1) 51.2 (18.9) < .0001 Sex, n (%) 0.0263 Female 25,098 (55.6) 34,591 (56.3) Male 20,028 (44.4) 26,848 (43.7) Race < .0001 White 35,576 (82.9) 42,577 (70.6) African American 3,451 (8.0) 9,433 (15.6) Hispanic 1,990 (4.6) 5,613 (9.3) Other 1,892 (4.4) 2,659 (4.5) Type of IBD Ulcerative Colitis 18,387 (40.7) 22,634 (36.8) < .0001 Crohn’s 27,046 (59.9) 39,150 (63.7) < .0001 Medical comorbidities, n (%) Smoking 395 (0.9) 831 (1.4) < .0001 Alcohol 1,084 (2.4) 2,157 (3.5) < .0001 Clostridioides difficile 2,105 (4.7) 2,981 (4.9) 0.1558 Bowel perforation 379 (0.8) 508 (0.8) 0.8178 Severe sepsis with shock 1,805 (4.0) 2,681 (4.4) 0.0035 Blood transfusion 2,758 (6.1) 3,678 (6.0) 0.3977 Primary payer, n (%) < .0001 Medicare 20,030 (44.5) 23,608 (38.5) Medicaid 3,713 (8.2) 13,328 (21.7) Private 19,675 (43.7) 18,745 (30.5) Self-pay, no charge, other 1,638 (3.6) 5,705 (9.3) Hospital location < .0001 Urban 42,706 (94.6) 56,353 (91.7) Rural 2,438 (5.4) 5,106 (8.3) Outcomes Length of stay, mean (SD) 5.1 (6.1) 5.6 (7.5) < .0001 In hospital mortality 642 (1.4) 953 (1.6) 0.016 Total hospital costs, mean/median $15968/$9952 $15670/$9449 0.01