Trends in Plasma Exchange Utilization in Optic Neuritis Hospitalizations in the United States

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Journal Article

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National Inpatient Sample; PLEX; hospitalization; optic neuritis; plasma exchange


PURPOSE: To report utilization trends of plasma exchange (PLEX) as well as sociodemographic and medical comorbidities associated with PLEX in the United States (US). DESIGN: Retrospective cross-sectional study. SUBJECTS: Adult patients (≥18 years old) admitted for inpatient hospitalization with a primary diagnosis of optic neuritis (ON). METHODS: Data from the National Inpatient Sample database was compiled to assess PLEX utilization rates between the year 2000 through 2020. The cohorts of patients receiving PLEX versus no PLEX were analyzed between quarter four of 2015 through 2020 (ICD-10 only) for patient sociodemographic variables, medical diagnoses, insurance types, hospital characteristics, etiology of disease, time-to-therapy, length of stay, and total charges incurred. MAIN OUTCOME MEASURES: Incidence of ON, incidence of PLEX, demographics, diagnoses associated with PLEX therapy, total charges, length of stay. RESULTS: From 2000 to 2020, 11209 patients hospitalized with a primary diagnosis of ON were identified with a significant majority managed at urban teaching hospitals. PLEX utilization increased steadily over two decades from .63% to 5.46%. Utilization was greatest in the Western US and least in the East. In the subset of ICD-10 cases, 3215 patients were identified. The median time to-therapy of PLEX was one day after admission, and PLEX utilization was highest in patients with neuromyelitis optica spectrum disorder (NMOSD) (21.21%) and lowest in multiple sclerosis-associated ON (3.80%). PLEX was associated with significantly longer length-of-stay and higher total charges incurred. Medical comorbidities associated with PLEX included adverse reaction to glucocorticoids (aOR, 31.50), hemiplegia (aOR = 28.48), neuralgia (aOR = 4.81), optic atrophy (aOR = 3.74), paralytic strabismus (aOR = 2.36), and psoriasis (aOR = 1.76). CONCLUSIONS: Over the last two decades in the US, PLEX therapy for ON has increased with the highest utilization in the Western US and for patients with the diagnosis NMOSD ON.