Influence of increase in hospital costs on mortality for pleural mesothelioma in teaching hospitals: A nationwide analysis.

Abstract

e20533 Background: Rural and non-teaching hospitals are known to have a lower budget compared to urban-teaching hospitals. Pleural mesothelioma is an aggressive and rare malignancy, and it remains unknown whether treatment in institutions with higher revenue or reimbursement rates impacts outcomes. This study sought to elucidate if such a difference in outcomes exists. Methods: A retrospective cohort analysis of adults admitted from 2016 to 2020 with the primary diagnosis of pleural mesothelioma was conducted. Data was extracted from the National Inpatient Sample Database. We compared outcomes such as mortality, length of stay (LoS), and total charges in teaching versus non-teaching hospitals. Results: We identified 7,320 patients that met inclusion criteria; 84% were admitted to teaching hospitals, and the remaining 16% to non-teaching facilities ( p < 0.001). Elderly patients were the most afflicted group, with a mean age of 72 to 74 years ( p 0.009). No differences in sex, race, or primary insurance distribution were noted ( p 0.067; p 0.731; p 0.801, respectively). The mean hospital LoS was 6.4 days in non-teaching hospitals compared to 7.7 days in teaching hospitals ( p 0.0061). In addition, Asians ( p 0.016), those with a median household income of 65,000 to 85,999 ( p 0.021), higher Charlson index ( p < 0.001), and those admitted to large to medium size hospitals ( p 0.011; p 0.001, respectively) had a positive linear relation to LoS. Moreover, total hospital charges were greater in teaching hospitals (120,100 USD) in comparison to non-teaching hospitals (73,883 USD) ( p < 0.001). Mortality did not differ based on teaching status ( p 0.643). However, Native Americans and those with higher Charlson comorbidity index were more likely to die ( aOR 21, p 0.004; aOR 1.32, p < 0.001, respectively). Conclusions: Hospital teaching status does not impact mortality in patients admitted with malignant pleural mesothelioma, even though teaching hospitals incur higher expenses on average. It does not come as a surprise due to this condition's known high mortality rate, late presentation in advanced stages, and resistance to current therapies. Prevention is key in a deadly disease, and more research is needed to offer a better prognosis; even though current regimens have shown improvement in survival, curative therapies are still unavailable. Even though asbestos is subject to strict regulations in the United States, it is not banned. We should revisit the idea of a complete ban; those most affected tend to have the least access to healthcare and need a safer work environment. Decreasing exposure to known carcinogens should also be a priority, as there is no better medicine than preventive medicine. Interestingly, mortality was greater in Native Americans compared to other races; the underlying causes are broad and need more research and better characterization of MM.