SUN-150 Complications of DKA in Teaching Vs. Non-Teaching Hospitals

Abstract

Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus responsible for more than 100,000 hospital admissions per year in the US [1]. Teaching hospital status has been associated with similar rates of mortality for various other inpatient conditions. Although, few studies have looked at differences in treatment outcomes of DKA depending on hospital teaching status [2]. We aimed to evaluate the differences in complications of DKA in teaching vs. non-teaching hospitals. Methods The National Inpatient Survey (NIS) database from 2011 to 2014 was reviewed. Patients with primary and secondary diagnosis of DKA on admission were identified by ICD-9 codes (250.1 and 250.3). Patients’ baseline characteristics and comorbidities were extracted. The Charlson Co-morbidity Index (CCI) was calculated for each patient. We compared baseline characteristics, comorbidities, mortality, length of stay, and complications of DKA between teaching and non-teaching hospitals. Statistical analysis was done using student's t-test, chi-square test, and binary logistic regression with level of α set at 0.05. Results A total of 8,080 and 10,911 patients were admitted for DKA to teaching and non-teaching hospitals, respectively. Length of stay for these patients was 4.61 days in teaching hospitals vs. 3.88 in non-teaching ones (p<0.001). Among these patients admitted for DKA, 4.1% died in teaching hospitals and 3.42% died in non-teaching ones (p<0.05). A higher proportion of patients with CCI >5 was observed in teaching vs. non-teaching hospitals (7.4% vs. 6%, p<0.05). When adjusted for CCI, mortality rate was similar in both settings (p=0.132). The DKA complication rates in teaching vs. non-teaching hospitals were as follows: Cerebral edema 0.1 % vs. 0.2% (p=0.12), pulmonary edema 0.1% vs. 0.09 % (p=0.5), altered mental status 1.8% vs. 1.9% (p=0.7), venous thrombosis 0.2% vs. 0.1% (p=0.33), pancreatitis 4.2% vs. 3.8% (p=0.16), seizure 2.2% vs. 1.8% (p<0.05) and aspiration 3.8% vs. 2.4% (p<0.001). Discussion Patients admitted to teaching hospitals had a higher mortality rate and longer length of stay, which could be attributed to a higher comorbidity index. There is no significant difference in DKA complications except for higher seizure and aspiration rates in teaching hospitals. The higher aspiration rate could be secondary to the higher seizure rate, which could be related to the higher comorbidity index in patients admitted to teaching hospitals.