MP58-06 HOSPITAL SAFETY NET BURDEN PREDICTS DISPARITIES IN PRESENTATION OF PATHOLOGIC FRACTURE IN METASTATIC PROSTATE AND RENAL CANCER

Abstract

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-06 HOSPITAL SAFETY NET BURDEN PREDICTS DISPARITIES IN PRESENTATION OF PATHOLOGIC FRACTURE IN METASTATIC PROSTATE AND RENAL CANCER Raj Bhanvadia, Fady Baky, Alex Kenigsberg, Yair Lotan, Jeffrey Howard, Xiasong Meng, Aditya Bagrodia, Vitaly Margulis, and Solomon Woldu Raj BhanvadiaRaj Bhanvadia More articles by this author , Fady BakyFady Baky More articles by this author , Alex KenigsbergAlex Kenigsberg More articles by this author , Yair LotanYair Lotan More articles by this author , Jeffrey HowardJeffrey Howard More articles by this author , Xiasong MengXiasong Meng More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Solomon WolduSolomon Woldu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hospital factors and access to care play a role in screening for and management of pathologic fracture (PFx) in metastatic prostate (mPCa) and renal cancer (mRCa). Higher safety net burden (SNB), a measure of the proportion of Medicaid and uninsured patients within a hospital population, has been associated with worse health outcomes. Using the National Inpatient Sample (NIS), we assessed risk factors for developing PFx secondary to mPCa or mRCa. We hypothesized patients at high SNB hospitals would experience higher rates of PFx secondary to mPCa and mRCa. METHODS: NIS was queried from 2013-2016 for all non-elective admissions for mPCa and mRCa. PFx was identified using ICD codes. SNB was divided into tertiles (Low, Medium, High) for demographic analysis, and a continuous variable on multivariate analysis. Separate multivariate logistic regression models were constructed to examine the association between increasing SNB and odds of diagnosis of PFx for mPCa or mRCa, respectively. Hospitalization cost, length of stay (LOS), and inpatient death were compared by SNB and cancer type. RESULTS: From 2013-2016, there were 30,385 and 14,355 non-elective admissions for mPCa and mRCa, respectively. Patients admitted at high SNB hospitals were younger, non-white, in the lowest income quartile, and treated at non-private hospitals (p <0.01). There was no difference in LOS, hospitalization cost, or discharge home for PFx by SNB. PFx accounted for a greater percentage of admissions for mRCa than mPCa (7.1% vs 5.6%, p <0.01). Admission for PFx among mRCa patients was associated with greater LOS [mean(SD) 8.3 (7.6) vs 6.9 (6.1), p <0.01], cost [mean(SD) $25,455 ($28,675) vs $18,397 ($18,284), p <0.01], and greater inpatient mortality (3.9% vs 2.4%, p=0.02) compared to mPCa. Increasing SNB predicted odds of presenting with PFx for mRCa (OR: 3.3, p <0.01), but not mPCa (OR: 1.0, p=0.9). CONCLUSIONS: Screening and management of bone lesions caused by mPCa is an established component of urologic practice; there are fewer guidelines for mRCa. Our results suggest that PFx account for a greater number of admissions for mRCa than mPCa, and that patients presenting to high SNB centers with mRCa are at increased risk of PFx. Fractures associated with mRCa were associated with greater LOS, cost, and mortality compared to mPCa. A greater focus on bone health in patients with mRCa may help prevent morbidity and mortality from PFx and help to improve on this health disparity. Further studies are needed to identify best practices and barriers to delivery of bone health-related care. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e990-e990 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raj Bhanvadia More articles by this author Fady Baky More articles by this author Alex Kenigsberg More articles by this author Yair Lotan More articles by this author Jeffrey Howard More articles by this author Xiasong Meng More articles by this author Aditya Bagrodia More articles by this author Vitaly Margulis More articles by this author Solomon Woldu More articles by this author Expand All Advertisement Loading ...