Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations

Authors

Sinan Akosman, Department of Ophthalmology, George Washington University, Washington, DC.
Renxi Li, Department of Ophthalmology, George Washington University, Washington, DC.
Bryan Kwon, Department of Ophthalmology, George Washington University, Washington, DC.
William West, Department of Ophthalmology, George Washington University, Washington, DC.
Masumi Asahi, Gavin Herbert Eye Institute, University of California Irvine, Irvine.
Keith J. Wroblewski, Department of Ophthalmology, George Washington University, Washington, DC.

Document Type

Journal Article

Publication Date

3-1-2024

Journal

JAMA ophthalmology

Volume

142

Issue

3

DOI

10.1001/jamaophthalmol.2023.6512

Abstract

IMPORTANCE: The length of stay (LOS) of hospitalizations may be a useful indicator of the burden of disease of corneal ulcers. Identifying variables associated with longer LOS may help to enhance delivery of care for high-risk patients. OBJECTIVE: To investigate the sociodemographic, social, and clinical factors associated with LOS in hospitalizations for corneal ulcers in the US. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of adult patients (aged >18 years) admitted with a primary diagnosis of corneal ulcer between quarter 4 of 2015 through 2020 and conducted using data from the National Inpatient Sample (NIS). Patients were stratified into 2 even cohorts based on LOS: LOS of 4 days or less and LOS greater than 4 days. Individual-level sociodemographic, social risk factors, and medical comorbidities associated with longer LOS were examined by multivariable regression. Data were analyzed from October 2015 to December 2020. EXPOSURE: Potential sociodemographics or medical comorbidities at hospital admission. MAIN OUTCOME AND MEASURE: The primary outcome of interest was factors associated with extended length of stay. The hypothesis being tested was formulated during data collection. RESULTS: A total of 1187 patients (mean [SD] age, 53.5 [20.9] years; 602 female [50.7%]) were included for analysis. The cohort with LOS greater than 4 days had higher total charges than the cohort with LOS of 4 days or less (mean [SD] charges, $79 504 [$86 719] vs $26 474 [$20 743]; P < .001). Sociodemographic variables associated with LOS greater than 4 days were Black race (adjusted odds ratio [aOR], 1.41; 95% CI, 1.03-1.92; P = .03), Medicare insurance (aOR, 1.42; 95% CI, 1.09-1.85; P = .009), and housing insecurity (aOR, 1.99; 95% CI, 1.29-3.06; P = .002). Medical comorbidities associated with LOS greater than 4 days were alcohol use (aOR, 1.50; 95% CI, 1.00-2.26; P = .05), dementia (aOR, 2.35; 95% CI, 1.36-4.07; P = .002), complicated diabetes (aOR, 1.75; 95% CI, 1.21-2.53; P = .003), uncomplicated diabetes (aOR, 1.57; 95% CI, 1.02-2.42; P = .04), drug misuse (aOR, 1.66; 95% CI, 1.08-2.57; P = .02), and legal blindness (aOR, 3.42; 95% CI, 1.19-9.82; P = .02). Based on NIS national estimates, corneal ulcers were estimated to have a direct annual health care expenditure of $35 819 590 in the US. CONCLUSION AND RELEVANCE: Corneal ulcer hospitalizations represent a significant burden of disease for patients and health care systems. This study highlights sociodemographic and clinical factors that may help clinicians identify high-risk patients vulnerable to complications and morbidity due to corneal ulcers.

APA Citation

Akosman, Sinan; Li, Renxi; Kwon, Bryan; West, William; Asahi, Masumi; and Wroblewski, Keith J., "Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations" (2024). GW Authored Works. Paper 4604.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4604

Department

Ophthalmology