Abstract 473: Will Obesity Bankrupt the United States? Obese Patients Who Underwent Cardiopulmonary Resuscitation Have Increased Thirty-Day Readmission and Total Hospital Cost

Abstract

Purpose: To determine the relationship between obesity and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who underwent cardiopulmonary resuscitation (CPR) during their hospitalization in the in the United States. Method: A retrospective study was conducted using the AHRQ-HCUP NRD for the year 2014. Adults (≥ 18 years) with a primary diagnosis of CPR (1), along with a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature (2). The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use. Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders (3). Results: 113,394 hospital admissions among adults with a primary and secondary diagnosis of CPR were identified, of which 14.8% were obese. 1:1 PS matching was performed based on demographic and clinical characteristics. The 30-day rate of readmission among obese and non-obese with CPR were 4.94% and 2.82% (p <0.001). The most common readmission for both groups was unspecified sepsis (17.3%). During the index admission for CPR, the length of stay (LOS) among obese and non-obese patients were similar (10.3 vs 9.4 days, p=0.16). However, the total cost for the obese patients was statistically different ($33,232 vs $33,692, p <0.001). Most importantly, obese patients’ in-hospital mortality rate during their index admission was significant higher (58.7% vs 6.72%, p <0.001). Amongst those readmitted, obese patients similarly had a significantly longer LOS than their non-obese counterparts (8.1 vs 4.5 days, p <0.001) and their total cost was more expensive ($19,027 vs $10,572, p <0.001). But, obese patients’ in-hospital mortality rate during their readmission was not significant different (0.34 % vs 0.08%, p =0.09). Obesity (HR 1.77, p <0.02) was an independent predictor associated with higher risks of readmission. Conclusion: In this study, obese patients admitted with CPR have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p <0.02) than non-obese patients.