Effect of Hospital Teaching Status on Outcomes of Diabetic Ketoacidosis

Thursday, May 12, 2022

4:10 PM – 4:25 PM

Location: Station 8, Sapphire West Foyer

Submitter(s)

MY
Mubarak H. Yusuf, MD
Resident Physician
Lincoln Medical Center
Bronx, New York, United States

Primary Author(s)

MY
Mubarak H. Yusuf, MD
Resident Physician
Lincoln Medical Center
Bronx, New York, United States

Co-Author(s)

AH
Ali Horoub
Internal Medicine Resident
NYC Health & Hospital/Lincoln
Bronx , New York, United States
YK
Yassine Kilani, MD
Resident Physician
Lincoln Medical and Mental Health Center
MA
Mohannad Al Khateeb, MD
Internal Medicine Resident
Lincoln Medical Center
Fortlee, New Jersey, United States
YA
Yazan Al Jabiri, MBBS
Resident
Lincoln Medical and Mental Health Center, New York, United States
MA
Mohammad Aldiabat
FA
Faridat M. Abdulkarim
Intern
University of Ilorin Teaching Hospital
Ilorin, Nigeria
MY
Maryam Yusuf, MD
Resident Physician
Federal Medical Centre, Katsina State

Objective:

Diabetic ketoacidosis (DKA) is one of the hyperglycemic complications of both type 1 and types 2 diabetes. Management requires inpatient admission and sometimes even intensive unit level of care depending on the severity presentation. Patients with DKA can either be managed in teaching or non-teaching hospital. We sought to investigate the effect of hospital teaching status on the outcome of patients admitted for DKA.

Methods:

We queried the National Inpatient Sample (NIS) 2016, and 2017 databases. The NIS is the largest inpatient hospitalization database in the United States. The numbers in the database are weighted to optimize national estimates. The NIS was searched for hospitalization of adult patients with diabetic ketoacidosis as a principal diagnosis using ICD-10 codes, this was further categorized based on hospital teaching status where patients were admitted. The primary outcome was inpatient mortality while secondary outcomes included cerebral edema, cardiac arrest, the mean length of stay (LOS) in days, total hospital cost (THC) in dollars. STATA software was used for data analysis. Cofounders adjusted with multivariable logistic and linear regression analysis.

Results:

There were about 367,555 adult hospitalizations principally for diabetic ketoacidosis, of which 38.7% were admitted at non-teaching hospitals and 61.3% were admitted to teaching hospitals. There was no difference in the mean age for both cohorts (40.7 vs 40.6). The overall inpatient mortality was 0.39% (1433) for hospitalizations due to DKA, compared with patients in nonteaching hospitals, those in teaching hospitals had higher mortality (0.41% vs 0.36%) which is not statistically significant. Other outcomes measures included odds of cerebral edema, and cardiac arrest (Table 1). Patients in teaching hospitals had a mean adjusted increase in LOS of 1.3 days (95% CI: 1.2–1.4, p<0.001) and an increase in total hospital cost of $15,962 (95% CI: 13,552-18,373, p<0.001) compared to those in non-teaching hospitals.