Cellulitis: Comorbidities as a determinant of hospital length-of-stay
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Background: Cellulitis is a common skin and soft-tissue infection that often recurs in some patients. Patients with presenting comorbid conditions may require hospitalization which increases the cost of treatment. However, little is known about comorbid conditions as determinants for a patient’s hospital length-of-stay. Objective: 1) To profile the characteristics of patients admitted to Ontario hospitals with a diagnosis of cellulitis according to key demographic, clinical and geographic factors; 2) To examine, among patients hospitalized with cellulitis, comorbidities as possible determinants of hospital length-of-stay. Methods: A retrospective cohort of 7863 patients was identified from the Discharge Abstract Database from April 1, 2006 to March 31, 2008. The Charlson Comorbidity Index was used to measure patients’ comorbidities. Univariate analyses were performed to describe the study population. The chi-square test was used to assess the association between categorical variables. The Kaplan-Meier product-limit method and log-rank test were used to estimate and to test the difference in the distributions of hospital lengths-of-stay between patients with and without comorbidities. Cox regression modeling was used to estimate the comorbidities’ effect on hospital length-of-stay while adjusting for confounding factors. The restricted means of lengths-of-stay were given to estimate and compare the average duration of hospitalization. The effects of specific Charlson comorbidities on hospital length-of-stay were similarly investigated. Results: Forty-six percent (3588/7863) of patients were diagnosed with Charlson comorbidities. Those patients were significantly older (p<.0001), and more likely to be female (p=.006) and to have lower limb cellulitis (p<.001) and C. difficile infections (p<.0001), compared to patients without comorbidities. Patients with comorbidities stayed significantly longer in hospital (8.0 vs. 5.3 days, p<.0001). Comorbidities independently decreased the instantaneous discharge rate by 37% (95% CI, 34% to 40%, p<.001). Hospital lengths-of-stay increased with increasing index of comorbidity. The means of hospital lengths-of-stay for patients with a cumulative index of 1, 2, 3, and 4 (or more than 4) were 7.4, 7.6, 8.8, and 9.7 days, respectively. Conclusion: The Charlson Comorbidity Index is predictive of longer hospital lengths-of-stay in adult patients diagnosed with cellulitis and may be a useful tool in the decision-making process during clinical management of these patients.