Abstract
BackgroundPatients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD.Methods and findingsWe utilized the 2016 National Inpatient Sample—a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59–0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33–0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57–2.17; p < 0.001) or patient-directed discharge (also referred to as “discharge against medical advice”) (aOR 3.47; 95% CI 2.80–4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts.ConclusionsOur findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.
Highlights
One of the many downstream consequences of the opioid crisis has been a marked increase in the incidence and associated costs of hospitalizations for serious bacterial infections associated with injection drug use such as endocarditis, osteomyelitis, septic arthritis, and epidural abscesses [1,2,3,4,5,6]
Our findings suggest that among hospitalizations for some serious infections, those involving patients with opioid use disorder (OUD) were associated with longer length of stay (LOS), higher odds of discharge to postacute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges
These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs
Summary
One of the many downstream consequences of the opioid crisis has been a marked increase in the incidence and associated costs of hospitalizations for serious bacterial infections associated with injection drug use such as endocarditis, osteomyelitis, septic arthritis, and epidural abscesses [1,2,3,4,5,6] Treatment of these infections usually requires a prolonged course of intravenous (IV) antibiotics, which can often be completed from home in patients without another indication for a rehabilitation stay [7,8,9,10,11]. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD
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