Lindsay A Gil1, Anai N Kothari2, Sarah A Brownlee1, Hieu Ton-That3, Purvi P Patel3, Richard P Gonzalez3, Fred A Luchette4, Michael J Anstadt5. 1. One:MAP, Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL; Stritch School of Medicine, Loyola University Chicago, Maywood, IL. 2. One:MAP, Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL; Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL. 3. Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL. 4. One:MAP, Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL; Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL; Edward Hines Jr., Veterans Administration Medical Center, Surgery Service Line, Hines, IL. 5. One:MAP, Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, IL; Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, IL. Electronic address: manstadt@lumc.edu.
Abstract
BACKGROUND: Health care spending is driven by a very small percentage of Americans, many of whom are patients with prolonged durations of stay. The objective of this study was to characterize superusers in the trauma population. METHODS: The National Trauma Data Bank for 2008-2012 was queried. Superusers were defined as those with a duration of stay in the top 0.06% of the population and were compared with the remainder of the population to determine differences in demographic characteristics, comorbidities, prehospital factors, and outcomes. Multivariate analysis was used to determine independent predictors of being classified as a superuser. RESULTS: A total of 3,617,261 patients met inclusion criteria, with 34,728 qualifying as superusers. Mean duration of stay for superusers was 58.7 days compared with the average 4.6 days (P < .001). Superusers were more likely to be male, black, Medicaid insured, and have a higher Injury Severity Score and lower Glasgow Coma Scale score. The hospital course of superusers was likely to be complicated by pneumonia, acute respiratory distress syndrome, decubitus ulcer, and acute kidney injury. CONCLUSION: Age, sex, race, and insurance were associated with prolonged use of inpatient care in the trauma patient population. Specific comorbidities and complications are associated with being a superuser. This subset of the trauma population confers a disproportionate burden on the health care system and can serve as a potential target for intervention.
BACKGROUND: Health care spending is driven by a very small percentage of Americans, many of whom are patients with prolonged durations of stay. The objective of this study was to characterize superusers in the trauma population. METHODS: The National Trauma Data Bank for 2008-2012 was queried. Superusers were defined as those with a duration of stay in the top 0.06% of the population and were compared with the remainder of the population to determine differences in demographic characteristics, comorbidities, prehospital factors, and outcomes. Multivariate analysis was used to determine independent predictors of being classified as a superuser. RESULTS: A total of 3,617,261 patients met inclusion criteria, with 34,728 qualifying as superusers. Mean duration of stay for superusers was 58.7 days compared with the average 4.6 days (P < .001). Superusers were more likely to be male, black, Medicaid insured, and have a higher Injury Severity Score and lower Glasgow Coma Scale score. The hospital course of superusers was likely to be complicated by pneumonia, acute respiratory distress syndrome, decubitus ulcer, and acute kidney injury. CONCLUSION: Age, sex, race, and insurance were associated with prolonged use of inpatient care in the traumapatient population. Specific comorbidities and complications are associated with being a superuser. This subset of the trauma population confers a disproportionate burden on the health care system and can serve as a potential target for intervention.
Authors: Alexandra W Acher; James R Barrett; Patrick B Schwartz; Chris Stahl; Taylor Aiken; Sean Ronnekleiv-Kelly; Rebecca M Minter; Glen Leverson; Sharon Weber; Daniel E Abbott Journal: J Gastrointest Surg Date: 2020-07-15 Impact factor: 3.452