ODP230 Outcomes of DKA Based on Hospital Teaching Status: A National Inpatient Sample Analysis
Authors: Ramirez Marcelo , Shaka Hafeez , Arguello Gabriela Sandino , Aguilera Maria 
Published: November 2022

Abstract

Introduction
Diabetic ketocidosis (DKA) is a serious complication of diabetes mellitus that is responsible for over 100,000 annual hospital admissions in the U. S. There is limited data comparing outcomes of patients with DKA based on the teaching status of the hospital. We aimed to evaluate any differences in terms of mortality, length of hospital stay (LOS) and healthcare burden in patients with DKA admitted in teaching versus non-teaching hospitals.

Methods
A retrospective cohort study was designed using data obtained from the 2018 National Inpatient Sample (NIS) database. Adult patients (age &gt;18) admitted with a principal diagnosis of DKA were identified using the international diseases classification code, tenthrevision (ICD-10). They were then stratified into two cohorts based on the teaching status of hospital where they were admitted. Primary outcomes assessed were, mortality, length of stay (LOS), total hospital charge and total hospital cost. Secondary outcomes included sepsis, myocardial infarction (MI), intubation, mechanical ventilation, pressors requirement, acute kidney injury (AKI), acute respiratory failure, cerebrovascular accident (CVA) and need for blood transfusion.

Results
Of the total of 116,710 patients hospitalized with DKA that were analyzed, 65.15% were admitted in teaching hospitals and 34.84% in non-teaching institutions. Most patients in teaching and non-teaching hospitals had an age range between 18 and 44 years (78.6% and 77.6% respectively). Median annual income was between USS1-58,999 in majority of patients admitted in both teaching and non-teaching hospitals (36.42% and 36.99% respectively). A slightly greater proportion of patients admitted in a teaching hospital had either Medicare, Medicaid or a private insurance (87.85% vs 85.35%; p&lt;0. 001). In-hospital mortality was higher in patient admitted in non-teaching institutions (0.22% vs 0.18%) however this was not statistically significant (p: 0.56). Mean LOS was longer in patients admitted in a teaching hospital (3. 05 vs. 2.66 days; p&lt;0. 001). Mean total hospital charges (US$30,978 vs US$25,989; p&lt;0. 001) and mean total hospital cost (US$7,271 vs US$6,942; p&lt;0. 001) were also greater in teaching institutions. Patients admitted in teaching hospitals had higher rate of mechanical ventilation (1.78% vs 1.34%; p: 0. 013) and pressors requirement (0.27% vs 0.14%; p: 0. 038). These patients also had increased rate of AKI (38.79% vs 32.51%; p&lt;0. 001) and acute respiratory failure (2.63% vs 1.94%; p: 0. 01). Other secondary outcomes including sepsis, MI, CVA, need for blood transfusion or intubation were not statistically significant.

Conclusion
Patients with DKA admitted in teaching hospitals had an increased length of stay, greater total hospital charge and cost. Some secondary outcomes including rate of AKI, acute respiratory failure, mechanical ventilation and pressors requirement were also greater in these patients. The teaching status of the institution did not have a statistically significant impact in terms of mortality or other secondary outcomes like sepsis, myocardial infarction or stroke.
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