Hospital admission patterns in adult patients with skin and soft tissue infections: Identification of potentially avoidable hospital admissions through a retrospective database analysis

Abstract

Background: Despite the substantial hospitalization costs associated with the management of patients with skin and soft tissue infections (SSTIs) in the inpatient setting, there is limited guidance on patients who should be managed in the hospital relative to the outpatient setting. Studies have demonstrated that SSTI patients without major complications or comorbidities can be successfully managed in the outpatient setting. However, there are limited data on current hospital admission patterns for patients with SSTI. Objectives: Given this literature gap, this study described the current hospital admission patterns among adult patients with SSTI using data from a US hospital research database. Methods: To determine the subset of hospitalized SSTI patients who could likely be managed in the outpatient setting (potentially avoidable hospital admissions), the distribution of hospital admissions was categorized by infection severity and Charlson Comorbidity Index (CCI) score. Results: During the study observational period, there were 610,867 medical encounters across 520 hospitals. Of the 610,867, 125,743 (20.6%) were treated as inpatients. Nearly all patients with life-threatening conditions or systemic symptoms or a CCI score of 2 or greater were admitted. Among those with no life-threatening conditions and no systemic symptoms, admission rates exceeded 10 and 30% for patients with a CCI score of zero and 1, respectively. While the admissions rates for these patient populations were low, they accounted for nearly 60% of all admissions (75,255 of 125,743 hospital admissions). On average, patients with CCI score of zero or 1, independent of the presence of systemic symptoms, were treated in the hospital for about 4 days, costing $6000–$7000 on average. Conclusions: Given the cost associated with the management of patients with SSTIs in the inpatient setting, the findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity.

Keywords:

• Bacterial infections
• skin diseases
• infectious
• skin infection
• staphylococcal
• economics
• medical

Acknowledgments

The authors would like to acknowledge Kevin Xiang (The Medicines Company) for his contributions to the statistical analyses presented in this manuscript and Caitlin Rothermel (MedLitera) for her editorial assistance in manuscript preparation.

Declaration of interest

This work was wholly funded by The Medicines Company, which employs two of the authors (KA Sulham and W Fan), who are also shareholders of the Company. TP Lodise has provided consulting services to The Medicines Company. Editorial work and manuscript preparation (Caitlin Rothermel, MedLitera) was funded by The Medicines Company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.