S. A. Brownlee1, H. Ton-That2, M. Anstadt2, R. Gonzalez2, A. N. Cobb1,2, P. C. Kuo1,2, A. N. Kothari1,2 1Loyola University Medical Center,One:MAP Division Of Clinical Informatics And Analytics,Maywood, IL, USA 2Loyola University Medical Center,Department Of Surgery,Maywood, IL, USA
Introduction: Recent attention has focused on the very small percentage of Americans who drive the majority of healthcare spending in this country. Included in this group are patients with prolonged inpatient length of stays – potentially accruing months' or even years' worth of hospital charges. The aim of this study was to characterize these superusers of postoperative care in an emergency general surgery population.
Methods: The Healthcare Cost and Utilization Project’s State Inpatient Database for FL, NY, IA, and WA from 2009-2013 were queried using ICD-9 codes for patients admitted with an emergency general surgery diagnosis and a related operating room procedure. Superusers were defined as patients with a length of stay in the top 0.06% of the population (characterizing them as having a rare condition based on Rare Diseases Act of 2002). Superusers were compared to patients with an average length of stay to determine baseline differences in demographic, comorbid, and clinical characteristics. Multivariable models were utilized to identify independent risk factors for classification as a superuser.
Results: 403,188 patients met our inclusion criteria with 264 patients qualifying as superusers (0.06%). Superusers had a length of stay >= 131 and mean length of stay of 174 days (SD=44.5). Maximum length of stay for a superuser was 359 days. Comparatively, the population average (mean) length of stay was 7 days (SD=9.2) and 20,767 patients ("average user") had a 7 day length of stay. Male sex (OR 1.4, P=0.04), Medicaid insurance (OR 2.0, P=.003), and African American race (OR 2.4, P<.001) were independently associated with classification as a superuser.
Conclusion: Patient factors including sex, insurance, and race are associated with prolonged utilization of inpatient care in an emergency general surgery population. Though superusers account for a small subset of this surgical population, they confer a disproportionate cost burden on the healthcare system. Early identification of these patients can allow targeted interventions to improve the efficiency of care delivery in emergency general surgery.
