1946. Heterogeneous Hospitalization Outcomes of People Who Use Drugs: The Type of Drug(s) Used Matters
Session: Poster Abstract Session: Clinical Practice Issues: OPAT
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek Poster Merchant.pdf (416.9 kB)
  • Background: U.S. hospitals are experiencing an increase in admissions for persons who use drugs (PWUD). We examined predictors of two outcomes—leaving AMA and 30-day readmission—among PWUD.

    Methods: We limited the 2013 National Readmissions Database to admissions of PWUD (age 18 to 65; ICD-9 codes for illicit drugs). Diagnoses and severity (Elixhauser comorbidity index (ECI)) were defined by ICD-9 codes. Uni- and multivariable logistic regression were performed.

    Results: Predictors of AMA included younger age, male gender, bacterial infection, overdose, and using more than one drug. Use of opioids with stimulants was associated with the highest rate of AMA discharge (AOR 1.81, 95% CI 1.76-1.86). Leaving AMA was not found to be associated with 30-day readmission (OR 0.99, 95% CI 0.96-1.03).

    Conclusion: PWUD represent a heterogenous patient population with hospital outcomes influenced by different patterns of drug use. Further exploration into these differences could have implications for predicting and intervening to prevent AMA discharges as well as 30 day readmissions, which are associated with worse outcomes and significant healthcare costs.

    Median [IQR] or N (%)

    N=1,773,194

    AMA N=1,211,883*

    30-day readmission N=1,211,883*

    OR

    AOR

    OR

    AOR

    Age

    44 [32, 53]

    0.98 (0.98, 0.98)

    0.983 (0.98, 0.98)

    0.999 (0.99, 1.00)

    --

    Female

    777,920 (44%)

    0.71 (0.70, 0.72)

    0.64 (0.63, 0.66)

    0.93 (0.91, 0.95)

    0.93 (0.91, 0.95)

    Bacterial Infection

    506,557 (29%)

    1.15 (1.13, 1.17)

    1.15 (1.12, 1.17)

    0.99 (0.97, 1.02)

    --

    Overdose

    105,291 (6%)

    1.18 (1.15, 1.21)

    1.15 (1.11, 1.19)

    0.91 (0.88, 0.95)

    0.90 (0.86, 0.95)

    AMA

    122,447 (7%)

    NA

    NA

    0.99 (0.96, 1.03)

    --

    Death During First Admission

    15,728 (1%)

    NA

    NA

    NA

    NA

    Drug Used:

    Opioids only

    356,363 (47%)

    REF

    REF

    REF

    REF

    Stimulants Only

    269,654 (35%)

    0.91 (0.89, 0.93)

    0.94 (0.92, 0.96)

    1.06 (1.03, 1.10)

    1.05 (1.02, 1.08)

    Opioids/Alcohol

    264,887 (8%)

    1.17 (1.14, 1.21)

    1.14 (1.11, 1.18)

    0.97 (0.92, 1.01)

    0.96 (0.92, 1.00)

    Opioids/Sedatives

    58,875 (8%)

    1.41 (1.37, 1.46)

    1.37 (1.32, 1.41)

    1.02 (0.97, 1.07)

    1.03 (0.98, 1.08)

    Opioids/Stimulants

    204,767 (27%)

    1.95 (1.89, 2.00)

    1.81 (1.76, 1.86)

    0.84 (0.80, 0.88)

    0.84 (0.80, 0.88)

    Elixhauser Comorbidity Index

    0-1

    466,653 (26%)

    REF

    REF

    REF

    REF

    2-3

    889,381 (50%)

    0.87 (0.86, 0.88)

    0.90 (0.88, 0.92)

    1.02 (0.99, 1.04)

    0.99 (0.96, 1.02)

    >3

    417,159 (24%)

    0.66 (0.64, 0.67)

    0.70 (0.68, 0.73)

    1.05 (1.02, 1.08)

    1.00 (0.96, 1.03)

    * Patients who died during index admission were removed from the logistic regression.

    Elisabeth Merchant, MD, Internal Medicine, Tufts Medical Center, Boston, MA, Deirdre Burke, MPH, Infectious Disease and Geographic Medicine, Tufts Medical Center, Tufts University, Boston, MA, Chanelle Diaz, MD, Internal Medicine, Montefiore Medical Center, New York, NY, Joshua Barocas, MD, Section of Infectious Diseases, Boston Medical Center, Boston, MA, Hansel Tookes III, MD, MPH, University of Miami Miller School of Medicine, Miami, FL and Alysse Wurcel, MD, MS, Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA

    Disclosures:

    E. Merchant, None

    D. Burke, None

    C. Diaz, None

    J. Barocas, None

    H. Tookes III, None

    A. Wurcel, None

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