Health-Care Utilization, Costs, and the Burden of Disease Related to Ano-rectal in the United States

Abstract

Introduction: Anorectal is an uncommon albeit lethal inpatient diagnosis, that could portend a poor prognosis.Limited data exists regarding the rate and costs associated with inpatient admissions for anorectal cancer. The aim of this study was to analyze a national database of U.S. hospitals to determine the incidence and inpatient costs of associated with anorectal cancer. Methods: We analyzed the National Inpatient Sample Database (NIS) for all subjects in which anorectal cancer on { Clinical classification software (CCS)code 15) was the principal discharge diagnosis during the period from 1997-2012. The NIS is the largest publicly available, all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each year. A Chi-squared test for trend was applied analyze the number of hospital discharges, the length of hospital stay (LOS) and the related hospital costs over the study period. Results: In 1997 there were 48,438 admissions with a principal discharge diagnosis of anorectal cancer as compared to 39,160 in 2012 (GoF test, p < 0.001). The rate of discharge per 100000 persons decreased from 16.1 0.5 to 12.5 0.3 (p < 0.001) over the same time period. Moreover, the mean LOS decreased by 14 % between 1993 and 2012 from 9.1 days to 7.8 days (p < 0.001). However, during this period the mean hospital costs increased by 207 % from $23,365 per patient in 1997 to $71,930 per patient in 2012 (p < 0.001,Figure 1). Furthermore, in-hospital mortality rate also decreased quite significantly from 3.75 % in 1997 to 1.93 % in 2012 (p < 0.001,Figure 2). Inpatinet mortality ijn 2012 was higher in patient residing in low income zip code( 2.03%),females (2.03%),rural area 3.42% and private hospital for profit compared to average mortality.Figure 1Figure 2Conclusion: The number of inpatient admissions and rate of discharge for anorectal cancer has markedly decreased over the last 16 years with a rise in hospital costs.The in-patient mortality rate, however, has decreased significantly. These trends may reflect improvement in the diagnostic and therapeutic modalities of gastric cancers, but further studies are needed to confirm this association.