The length of stay and inpatient burden in inpatients with different psoriasis subtypes

Abstract

Background: Heavy disease burden of psoriasis has been indicated by previous studies. However, the cost of care and length of stay (LOS) in inpatients with different psoriasis subtypes were rarely addressed. This study aimed to investigate the cost of care and LOS in Chinese patients with different psoriasis types and to clarify the independent factors affecting LOS. Methods: We conducted a cross-sectional study by enrolling patients with psoriasis who were hospitalized between 13 Feb 2017 and 29 Mar 2021. Demographic and clinical characteristics of the patients were collected by reviewing their Electronic Medical Records. Multivariate linear regression was used to estimate the associations with adjustments. Results: A total of 310 adult patients with psoriasis were included (mean cost of care: 13.0±22.3 kCNY; mean LOS: 7.9±4.3 days). Statistically significant differences were found among patients with different psoriasis subtypes in LOS (P<0.001) but not in the cost of care (P=0.530). Relative to psoriasis vulgaris, pustular psoriasis (Adjusted coefficient: 2.37, 95% confidence interval (CI): 0.87-3.87) and erythrodermic psoriasis (Adjusted coefficient: 2.92, 95%CI: 1.38-4.47) were significantly associated with an increased LOS. Meanwhile, respiratory tract infections (Adjusted coefficient: 1.60, 95%CI: 0.11-3.10) also significantly increased the LOS. On the contrary, a decreased LOS was found in psoriatic arthritis patients treated with TNF-alpha inhibitors (Adjusted coefficient: -2.21, 95%CI: -4.37 to -0.05). Conclusions: LOS differed significantly among different psoriasis subtypes while the inpatient burden for a single hospitalization was alike. Infection is an important factor associated with a longer LOS. TNF-alpha inhibitors evidently reduced the total hospital stay period for patients with psoriatic arthritis.

Keywords: burden; cost of care; inpatient; length of stay; psoriasis; psoriatic arthritis.

Figure 1

The violin plots were constructed to display the distributions of cost of care (a) and length of stay (b) in different psoriasis types. The plots indicate the smoothed densities of each distribution, and boxplots indicating medians and upper and lower quartiles. Asterisks show statistically significant differences with P values <0.01 (**) and <0.001 (***).

Figure 2

Factors associated with increased length of stay. Adjusted coefficients were yielded from multivariate linear regression modeling, and stepwise regression was conducted. Other bacterial infections including urinary tract infection, bacteremia, digestive tract infection and liver abscess. PsV: psoriasis vulgaris; PsA: psoriatic arthritis; PP: pustular psoriasis; EP: erythrodermic psoriasis.