Abstract A29: Multilevel factors associated with increased in-hospital length of stay among patients following head and neck cancer treatment
Authors: Boakye Eric Adjei , Tobo Betelihem B. , Chen Jiajing , Buchanan Paula , Malik Shubhra , Osazuwa-Peters Nosayaba 
Published: February 2019

Background: Head and neck cancer (HNC) treatment often involves extensive surgical procedures, which require patients to be hospitalized. Increased hospital stay following HNC treatment contributes substantial costs to both the patient and the hospital, and is considered an indicator of quality of care. Cost containment is at the forefront of responsible health care delivery, and one way to decrease costs is to decrease hospital length of stay (LOS). To reduce hospital LOS and decrease cost of treating HNC patients, it is important to first characterize factors associated with increased hospital LOS. However, data are lacking on factors contributing to increased LOS in patients with HNC. This study aims to examine predictors of length of stay among patients following HNC cancer treatment in a national sample.

Methods: Data on 75,984 hospital records from the Nationwide Inpatient Sample 2008 – 2013 with a diagnosis of HNC using the International Classification of Diseases, ninth edition, were examined. The outcome variable, LOS, was calculated by subtracting the admission date from the discharge date, with same-day stays coded as 0. Patient level characteristics included age, sex, race, insurance type, residential income, comorbidity score, metastatic cancer status, and anatomic site. Hospital-level characteristics included hospital teaching status, hospital bed size, and hospital regional location. Weighted, multilevel generalized model was used to assess correlates of LOS.

Results: Mean LOS among cases was 6.7 ± 8.0 days. The adjusted multilevel analysis indicated that patients with advanced comorbidities (b = 2.17 per 1 unit increase in Elixhauser comorbidity score, 95% CI = 1.66 – 2.69) were more likely to have a longer LOS. Compared with women, men were more likely to have a longer LOS (b = 0.20, 95% CI = 0.06, 0.33), as well as African Americans (b = 0.31, 95% CI = 0.11, 0.49) compared with Caucasians. In addition, patients with Medicaid (b = 1.38, 95% CI = 1.19, 1.58) vs. private insurance payers and those with metastatic cancer (b = 1.21, 95% CI = 1.07, 1.35) had longer LOS. Patients were more likely to have longer LOS if the sites of their cancer were floor of the mouth (b = 3.51, 95% CI = 3.12, 3.89), hypopharynx (b = 3.05, 95% CI = 2.68, 3.41), gum (b = 2.79, 95% CI = 2.34, 3.23), or larynx (b = 2.43, 95% CI = 2.15, 2.70) compared with salivary gland. Hospital-level factors also were associated with LOS among HNC patients in the adjusted multilevel model. Patients admitted to hospitals located in the South (b = -0.82, 95% CI = -1.11, -0.52), Midwest (b = -1.63, 95% CI = -1.98, -1.28), and West (b = -0.73, 95% CI = -1.08, -0.39) had shorter LOS compared with those admitted to hospitals located in the Northeast. Finally, patients admitted to a nonteaching hospital (b = -0.87, 95% CI = -1.08, -0.66), and small bed size (b = -0.95, 95% CI = -1.30, -0.60) or medium bed size (b = -0.58, 95% CI = -0.82, -0.34) hospital vs. large bed size had shorter LOS.

Conclusion: Other than the index head and neck cancer, comorbidities seem to be the most important factor associated with increased patient LOS. Additionally, male patients, African Americans, those who had Medicaid insurance, had metastatic cancer, and were admitted to a teaching hospital were more likely to stay at the hospital longer. Understanding these factors associated with increased LOS will help efforts to decrease health care cost and improve quality of care.

Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Jiajing Chen, Paula Buchanan, Shubhra Malik, Nosayaba Osazuwa-Peters. Multilevel factors associated with increased in-hospital length of stay among patients following head and neck cancer treatment [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A29.