Complications and outcomes of hospitalizations for patients with and without Parkinson disease

Abstract

Objective: To examine complications and outcomes of hospitalizations for common indications for hospitalization among patients with Parkinson disease (PD).

Methods: We identified and selected the ten most common indications for hospitalization among individuals ≥65 years of age using principal diagnoses from the California State Inpatient Database, 2018-2020. Patients with comorbid PD were identified using secondary diagnosis codes and matched one-to-one to patients without PD based on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching). We identified potentially preventable complications based on the absence of present on admission indicators among secondary diagnoses. In the matched cohort, we compared inpatient complications, early Do-Not-Resuscitate (DNR) orders (placed within 24 h of admission), use of life-sustaining therapies, new nursing facility requirement on discharge, and death or hospice discharge for patients with and without PD.

Results: We identified 35,457 patients with PD among the ten leading indications for hospitalization in older adults who were matched one-to-one to patients without PD (n = 70,914 in total). Comorbid PD was associated with an increased odds of developing aspiration pneumonia (OR 1.17 95% CI 1.02-1.35) and delirium (OR 1.11 95% CI 1.02-1.22) during admission. Patients with PD had greater odds of early DNR orders [placed within 24 h of admission] (OR 1.34 95% CI 1.29-1.39). While there was no difference in the odds of mechanical ventilation (OR 1.04 95% CI 0.98-1.11), patients with PD demonstrated greater odds of tracheostomy (OR 1.41 95% CI 1.12-1.77) and gastrostomy placement (OR 2.00 95% CI 1.82-2.20). PD was associated with greater odds of new nursing facility requirement upon discharge (OR 1.58 95% CI 1.53-1.64). Patients with PD were more likely to die as a result of their hospitalization (OR 1.11 95% CI 1.06-1.16).

Conclusion: Patients with PD are at greater risk of developing aspiration pneumonia and delirium as a complication of their hospitalization. While patients with PD more often have early DNR orders, they have greater utilization of life-sustaining therapies and experience worse outcomes of their hospitalization including new nursing facility requirement upon discharge and greater mortality.

Keywords: Parkinson disease; aspiration; complications; delirium; epidemiology; hospitalization; mortality; outcomes.

Figure 1

Selection methods. CCSR, Clinical Classification Software Refined. Patients with Parkinson disease were matched one-to-one to patients without Parkinson disease on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching).

Figure 2

Rank order of the top ten indications for hospitalization among unmatched older adults (A) without Parkinson disease and (B) with Parkinson disease, unmatched. COPD, Chronic Obstructive Pulmonary Disease. Principal diagnoses were grouped based on ICD-10 codes into clinically meaningful categories using Clinical Classification Software Refined from the Healthcare Cost and Utilization Project.

Figure 3

Indications for hospitalization among unmatched older adults (A) without Parkinson disease and (B) with Parkinson disease by percent. UTI, Urinary Tract Infection; COPD, Chronic Obstructive Pulmonary Disease.

Figure 4

Complications and outcomes for matched patients with and without Parkinson disease. PD, Parkinson disease; OR, Odds Ratio; DVT, Deep Venous Thrombosis; C. difficile, Clostridium difficile; DNR, Do-Not-Resuscitate. ^aOdds ratios were calculated using conditional logistic regression to assess the association between comorbid Parkinson disease and complications or outcomes in the matched cohort. ^bIleus includes paralytic ileus as well as other reduced motility gastrointestinal complications. ^cIdentifies in-hospital cardiac arrest. Excludes individuals with DNR orders to avoid bias from advance directives. ^dEarly DNR includes patients with DNR orders placed within 24 h of admission to the hospital. ^eNew nursing facility need analyzes discharges to a nursing facility but excludes individuals admitted from a nursing home to avoid bias from point of origin. ^fDeath includes inpatient mortality and discharge to hospice (i.e., total mortality equivalence).

Figure 5

Mortality rate by indication for hospitalization for matched patients with and without Parkinson disease. COPD, Chronic Obstructive Pulmonary Disease. Mortality rate is calculated per 100 hospitalizations for Parkinson disease vs. no Parkinson disease. p < 0.05 is considered statistically significant.