A0345 - Impact of Malnutrition on Resource Utilization in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Muhammad Haseeb, MD, MSc

Beth Israel Deaconess Medical Center
Boston, MA

Maham Waqar, MBBS¹, Umar Hayat, MBBS², Fnu Faheela, MBBS³, Muhammad Kamal, MD⁴, Osama Abu-Shawer, MD, MS⁵, Ali Raza, MBBS, FCPS³, Muhammad Haseeb, MD, MSc⁶
¹King Edward Medical University, Lahore, Punjab, Pakistan; ²University of Kansas, Wichita, KS; ³Nishtar Medical University, Multan, Punjab, Pakistan; ⁴Essen Healthcare System, New York, NY; ⁵Cleveland Clinic, Cleveland, OH; ⁶Beth Israel Deaconess Medical Center, Boston, MA

Introduction: Malnutrition is a major complication of Inflammatory Bowel Disease (IBD), which is associated with poor clinical outcomes. The prevalence of malnutrition in IBD patients ranges from 18% to 85%, with a higher prevalence in hospitalized patients. Our study aimed to assess the prevalence of malnutrition in patients admitted with IBD and its influence on resource utilization in the US.

Methods: National Inpatient Sample (NIS) for 2019 was queried using ICD-10-CM Codes to identify a cohort of inpatient IBD admissions with and without malnutrition. First, a weighted sample was used to get baseline characteristics and resource utilization (length of stay and total hospital charges) during the inpatient admissions. Then, multivariate linear regression analysis followed by predictive margins of the model was used to get adjusted estimates of the length of stay and total hospital charges.

Results: Among 92,740 patients hospitalized with IBD, 14420 (15.6%) patients had a concurrent diagnosis of malnutrition. Compared to males, there was less proportion of females having malnutrition (54.9% vs. 49.6%). Mean age was similar in IBD patients with and without malnutrition (47.4 years vs. 46.5 years). Compared to patients with malnutrition, there were larger proportions of patients with private insurance without malnutrition (45% vs. 48.4%). Malnutrition was associated with a significantly longer length of stay in IBD patients, 8.88 days (95% CI 8.52-9.24) vs. 4.23 days (95% CI 4.16-4.30) for patients without malnutrition in the adjusted model. Total hospital charges were also higher, $ 91392 (95% CI 83771-99014) with malnutrition vs. 44798$ (95% CI 42955-46640) for patients without malnutrition. Mortality was also higher in patients with malnutrition.

Discussion: Our study shows that malnutrition was quite prevalent in hospitalized IBD patients. It was associated with increased mortality in the hospitalized cohort and prolonged length of stay. In addition, it resulted in increased hospital charges. Early recognition and intervention can improve health outcomes for patients with IBD. Future studies should also assess predictors for developing malnutrition in this patient population.

Figure: IBD: Inflammatory Bowel Disease; IBD+Malnutrition: Inflammatory Bowel Disease with Malnutrition

Variables	IBD without Malnutrition (78320)	IBD with Malnutrition (14420)	p-value
a) Baseline Patient and Hospital Characteristics
Age (SD)	46.5 (18.1)	47.4 (19.3)	0.03
Female (%)	43030 (54.9)	7150 (49.6)	< 0.01
Race (%)			0.33
White	56745 (73.9)	10360 (73.8)
Charlson Comorbidity Index (SD)	0.70 (1.3)	0.86 (1.5)	< 0.01
Hospital Type (%)
Urban	72735 (92.9)	13860 (96.1)	< 0.01
Teaching	59765 (76.3)	12090 (83.8)	< 0.01
Hospital Bed Size (Large)	39620 (50.6)	8575 (59.5)	< 0.01
Payer Information (%)			< 0.01
Medicare	20610 (27.4)	4405 (31.7)
Private Insurance	36495 (48.4)	6250 (45.0)
Disposition (%)			< 0.01
Home AMA Died	66595 (85.0) 1955 (2.5) 105 (0.1)	9550 (66.3) 170 (1.2) 165 (1.2)
b) Resource Utilization
LOS (Unadjusted)	4.19 (95% CI 4.11-4.26)	9.07 (95% CI 8.71-9.44)	< 0.01
LOS (Adjusted)	4.23 (95% CI 4.16-4.30)	8.88 (95% CI 8.52-9.24)	< 0.01
TOTAL CHARGES (Unadjusted)	44064 (95% CI 42229-45899)	94056 (95% CI 86272-101841)	< 0.01
TOTAL CHARGES (Adjusted)	44798 (95% CI 42955-46640)	91392 (95% CI 83771-99014)	< 0.01

Table: Adjusted for Age, Charlson Comorbidity Index, Hospital (Location, Teaching status, Bed Size), Insurance status.
IBD: Inflammatory Bowel Disease; SD: Standard Deviation; AMA: Against Medical Advice; LOS: Length Of Stay

Disclosures:

Maham Waqar indicated no relevant financial relationships.

Umar Hayat indicated no relevant financial relationships.

Fnu Faheela indicated no relevant financial relationships.

Muhammad Kamal indicated no relevant financial relationships.

Osama Abu-Shawer indicated no relevant financial relationships.

Ali Raza indicated no relevant financial relationships.

Muhammad Haseeb indicated no relevant financial relationships.

Maham Waqar, MBBS¹, Umar Hayat, MBBS², Fnu Faheela, MBBS³, Muhammad Kamal, MD⁴, Osama Abu-Shawer, MD, MS⁵, Ali Raza, MBBS, FCPS³, Muhammad Haseeb, MD, MSc⁶. A0345 - Impact of Malnutrition on Resource Utilization in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.