Investigator University of Pennsylvania, United States
Introduction: There are multiple known factors, such as Mallampati Class III or higher, small mouth opening, and short thyromental distance, that put patients at an increased risk for difficult intubation. When intubating these patients, sometimes intubation is unsuccessful and the medical team must rely on other methods to help ventilate and oxygenate the patient. Our study aims to evaluate the effects of the type of hospital institution on mortality, LOS, and total charges in patients who ended up having failed intubations.
Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify adults with the ICD-10 diagnostic/procedural codes for failed or difficult intubation. Multivariate logistic regression analysis was used to obtain the odds ratios (OR) of inpatient mortality. Multivariate linear regression was used to determine the average length of hospital stay (LOS) and average total hospitalization charges (TOTCHG) with respect to type of hospital. Weighted analysis using Stata 17 MP was performed.
Results: A total of 4,459 adult patients were identified to have failed intubation, of which 618 died.
There was no statistically significant difference in mortality between urban teaching, urban nonteaching, rural teaching, and nonteaching hospitals. We found that rural hospitals have a significantly lower LOS (-2.09, p< 0.05, CI -3.95 - -0.22) compared to urban non-teaching hospitals.
There was no significant difference noted between urban nonteaching and urban teaching hospitals. However, rural hospitals have significantly lower TOTCHG (-$74,147.06, p< 0.05, Cl -96,368.71 - -51.925.40).
Conclusions: Our study found that there was no significant difference in mortality rate between any type of hospital. However, rural teaching and nonteaching hospitals had a lower LOS and lower TOTCHG in comparison to that of urban hospitals. LOS and TOTCHG did not differ between urban teaching and nonteaching hospitals. Additional resources should be allocated towards identifying more cost effective treatment in urban hospitals.
