(642) Association of Obesity and Resource Utilization in Hospitalized Patients With Diabetic Ketoacidosis

Introduction: Recent research reports that obesity is associated with higher in-hospital mortality for patients with a diagnosis of diabetic ketoacidosis (DKA). However, the population-level association of obesity with ICU admission, total hospital charges, and hospital length of stay (LOS) for patients with a principal diagnosis of DKA have not been reported.

Methods: We used a deidentified statewide dataset to study hospitalizations aged ≥ 18 years in acute care hospitals in Texas with a principal diagnosis of DKA from 2016 through 2021. Obesity was identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes selected from Clinical Classification Software Refined (CCSR) Category END009. DKA was identified using ICD-10-CM codes chosen from the CCSR Categories END003, END005, END006, and NVS013. Multilevel logistic regression was used to estimate the association of obesity and ICU admission. Multilevel negative binomial regression was applied to measure the association of obesity with LOS and total hospital charges. Average marginal effects (AME) and 95% confidence intervals (95% CI) were computed for the associations of obesity with LOS and total charges.

Results: There were 103,973 hospitalizations with a principal diagnosis of DKA from 2016-2021, of which 13,649 (13.1%) were obese. Compared to nonobese hospitalizations, obese hospitalizations had a similar rate of ICU admission (83.5% vs. 82.5%), higher mean [SD] length of stay (3.78 [3.32] days vs 3.23 [3.59] days), and higher mean [SD] total hospital charges (46,083[51,279] vs 39,066[43,844]). Following risk adjustment for confounders, obesity was not associated with ICU admission (adjusted odds ratio [aOR] 1.00 [95% CI 0.95-1.06]) but associated with higher LOS (incident rate ratio [IRR] 1.16 [95% CI 1.15 – 1.18], AME 0.5253 days [95% CI 0.4782 – 0.5724]), higher total charges (IRR 1.13 [95% CI 1.12 – 1.14], and AME $5,066 [95% CI $4,498 - $5,634]).

Conclusions: For patients with a principal diagnosis of DKA, obesity was not associated with ICU admission. Obesity was significantly associated with higher LOS and higher total hospital charges. Research investigating the needs of this population can guide efforts to reduce disparities.