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Drivers Of Increased Hospital Resource Utilization In 15,510 Hand Infection Patients
Ping Song, MD1, Corey Bascone, MD, MBA1, Austin D. Chen, MD2, Abbas Peymani, MD2, David Chi, MD, PhD3, Samuel J. Lin, MD, MBA2, Andrew Li, MD1.
1University of California, Davis, Sacramento, CA, USA, 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 3Washington University Medical Center, Saint Louis, MO, USA.

PURPOSE: Hand infections are commonly encountered, with severe cases often necessitating surgical intervention and hospitalization. This study aims to characterize patient and hospital level factors associated with increased hospital resource utilization.
METHODS: Patients with a primary diagnosis of hand infection and primary intervention of incision and drainage were retrieved from the Healthcare Cost and Utilization Project National Inpatient Sample Database (2014-2015). A gamma regression with a log-link function was performed to adjust for confounders and to identify drivers of increased length of stay (LOS), hospital costs, as well as procedural delay following admission. Reference groups for regression were White race, age <65 years, 1st income quartile, private insurance, Elixhauser Comorbidity Index (ECI): 0, Northeastern region, small hospital size, and rural hospital setting.
RESULTS: There were 15,510 identified patients. Significant drivers of increased LOS included non-White race (Black: 0.190 days, Hispanic: 0.560 days, other minority: 0.654 days), age >65 years (0.448 days), income in the 3rd quartile (0.152 days), non-private insurance status (Medicare: 0.496 days, Medicaid: 0.256 days, self-pay: 0.298 days, no charge: 0.104 days, other: 0.284 days), ECI (1: 0.219 days, 2: 1.132 days), and Southern region (0.179 days). Drivers of increased hospital costs included non-White race (Black: $971.33, Hispanic: $951.44, other minority: $1674.45), income quartile (3rd: $369.11; 4th: $536.04), non-private insurance (Medicare: $816.37, Medicaid: $332.19, self-pay: $308.15, other: $401.94), ECI (1: $326.23; 2: $2049.26), and Western region ($2045.90). Notably, the factors associated with a delayed procedural day overlapped with these findings. Hispanic (0.110 days), non-private insurance status (Medicare: 0.107 days, no charge: 0.377 days), and increased ECI (1: 0.111 days, 2: 0.304 days) patients received incision and drainage at a significantly delayed time following admission.
CONCLUSION: Our results suggest that increased hospital resource utilization for severe hand infections requiring incision and drainage and hospitalization is largely associated to racial minority, non-private insurance status, and increased comorbidity status, rather than hospital-level influences. A delay in procedural day is similarly affected by these factors. Measures to identify factors within these specific populations and subsequent changes to optimize management pathways may decrease the healthcare burden of hand infections.


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