Patient Characteristics Affect Discharge Status for Opioid-related Infective Endocarditis

Abstract

Background: Opioid overdoses have increased dramatically in the last 20 years, but secondary complications, such as infective endocarditis (IE) are also on the rise.

Objective: The objective of this study was to understand the effect that opioid-related IE has on hospitals across the US and to understand the disposition of patients after treatment for IE, particularly in regard to insurance status and type.

Research design: Secondary data analysis of the publicly-available 2015 Nationwide Inpatient Sample (NIS) was used to assess opioid-related IE based on patient and hospital characteristics. Bivariate and logistic regression was calculated to determine significance between the outcome variable (IE) and other covariates.

Subjects: The 2015 NIS data contained 7,153,989 weighted observations with 5760 (0.02%) incidences of opioid-related IE.

Measures: The NIS dataset represents a 20% stratified sample of all US hospitalizations across all payors in a given year. Opioid-related IE was the outcome variable measured through ICD-9 and ICD-10 codes, and the independent variables included the patient's age, sex, primary payer, household income, discharge status, length of stay, and transfer status, and the hospital's size, ownership, region, and location with teaching status.

Results: Routine discharge was the top discharge status across all payors, except Medicare. Nearly 26% of self-pay patients were discharged against medical advice. Logistic regression results indicate that patients who are younger, uninsured, have increased condition severity, have longer lengths of stay, and are discharged against medical advice or transferred to a short-term hospital or other health facility experienced significantly higher odds of opioid-related IE admissions as compared with all other admissions. The only significant hospital characteristic was region.

Conclusions: The fact that patient disposition varied across different payors suggests that hospitals are missing opportunities to engage the most vulnerable patients with IE. Given the long-term care required by this condition, hospitals are well-positioned to participate in interventions to initiate substance abuse treatment and help patients navigate outpatient substance abuse treatment options.