Clinical outcomes in hospitalized sickle cell patients with palliative care consults Free

Introduction

The use of palliative care in patients with sickle disease has been largely understudied. The research that has been done demonstrate significant underutilization of palliative consults in hospitalized patients. Historically, palliative care has played a large role in oncologic care to enhance illness/prognostic understanding, goals of care, and manage symptoms (such as pain and nausea). However, the role of palliative care in management of patients with hematologic conditions has not been well established. There have been few studies highlighting the need for palliative care in this setting, but even fewer studies showing actual outcomes of patients who receive palliative consults. This study helps to bridge that gap by focusing on hospital outcomes (mortality, length of stay (LOS), total charge, and disposition) and other associations of sickle cell patients that received palliative consults while hospitalized compared to their counterpart that did not using the National Inpatient Sample (NIS) database of hospitalized patients from 2017-2022

Methods

The NIS databases (2017–2022) of the Healthcare Cost and Utilization Project (HCUP) were used to identify patients admitted with a primary diagnosis of sickle cell disease, sickle cell/Hb-C disease, and sickle cell beta thalassemia. We applied discharge weight (DISCWT) provided in the database to generate the national estimates. The primary population was further broken down into two groups where one had palliative care involvement and the other did not. Palliative care involvement in this group was identified by ICD 10 code for palliative consults. Pearson Chi-square test for categorical variables was applied to compare the baseline demographics and hospital characteristics between the groups. The objective of the study was to determine demographic factors and hospital outcomes of sickle cell patients that received palliative consults. Multivariate linear and logistic regression models were used to adjust for confounders such as demographics, insurance, and Charleston comorbidity indices.

Results

437,049 patients were hospitalized between 2017 and 2022 with a primary diagnosis of either sickle cell disease, SS-Hb-C, or sickle cell beta thalassemia, and out of these, 4,134 patients received a palliative care consult. Patients who received palliative consults tended to be older (especially over 65), have higher comorbidity scores (Charlson Index 2 or 3), and were more likely to have higher median incomes. They were also more frequently treated in larger teaching hospitals and in regions such as the Northeast, Midwest, and South. No significant differences were found in sex, race, or insurance status between those who did and did not receive palliative care. After adjusting for confounders, there were higher odds of mortality in hospitalized sickle cell patients with palliative consults (aOR:24; 95% CI 17-34; p-value <0.001). Hospitalized sickle cell patients that received palliative care consults also had a higher total hospitalization charge ($93,000 vs $40,000) (95% CI 79k-105k; p-value <0.001) and a higher length of stay (10.8 days vs 5.8 days) (95% CI 9-11; p-value <0.001).

Conclusion

In this study, we found that palliative care consults for hospitalized sickle cell patients were associated with a statistically significant increase in mortality, LOS, and total charge of admission. Previous studies have theorized the benefit of palliative care involvement in sickle cell patients, but there is sparse data to quantify the outcomes. This study helps bridge the gap of knowledge by looking at outcomes for hospitalized sickle cell patients that received palliative care. Additionally, while the data may demonstrate an association between the variables; this does not establish causation. The higher odds of mortality, LOS, and total charge within the palliative consult group may be a result of a more complex admission requiring more extensive care. Things to expand on in future work include comparing the role of palliative in more complex vs simple admissions and examining the use of palliative care in the outpatient setting.