Patient safety events in hospital care of individuals with epilepsy

Abstract

Summary Objectives (1) To describe patient adverse events (PAEs) experienced by hospitalized individuals with epilepsy and examine the association of an epilepsy diagnosis on risk of specific PAEs; (2) to examine the impact of a PAE on (a) length of stay (LOS), (b) inpatient death, and (c) use of institutional post‐acute care. Methods We applied the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) software to the National Inpatient Sample database to identify potential medical and postoperative PAEs among >72 million hospitalizations of adults in the United States from 2000 to 2010. Logistic regression models compared the odds of experiencing each PAE between hospitalizations of persons with epilepsy (PWE) and the general inpatient population. We also examined the impact of experiencing a PAE on LOS, inpatient death, and discharge disposition. Results Hospitalized PWEs were at increased risk for specific postoperative PAEs: fall with hip fracture (Adjusted Odds Ratio, AOR 1.90, 1.21–2.99), respiratory failure (AOR 2.64, 2.43–2.87), sepsis (AOR 1.41, 1.21–1.63), and preventable postoperative death (AOR 1.25, 1.15–1.36). The odds of perioperative pulmonary embolism/deep vein thrombosis (AOR 1.65, 1.57–1.73), skin pressure ulcer (AOR 1.25, 1.22–1.29), and central venous catheter‐related bloodstream infections (AOR 1.24, 1.17–1.32) were also greater among hospitalizations of PWEs. Experiencing a PAE was associated with a prolonged mean length of stay (15 days vs. 5 days, t‐test p < 0.001), a 416% increase in the odds of inpatient death (AOR 4.16, 3.95–4.38), and a 282% increase in use of high‐level post‐acute care (AOR 2.82, 2.72–2.93). Significance Hospitalized adults with epilepsy are vulnerable to specific safety‐related adverse events, and these potential patient safety failures substantially impact outcomes and resource use. Efforts to reduce long‐term disability and improve the value of care delivered to PWEs may need to consider provider‐level interventions to reduce adverse events.

Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study

“…However, long LOS was a common occurrence among elderly patients who were admitted with seizures or who experienced seizures throughout hospitalization. The identification of predictors of long LOS among inpatients with seizures is a matter of interest in that we can avoid its consequences, such as increased morbidity and mortality, and higher healthcare costs 4 . Although hospital mortality was not a subject discussed in this study, it is worth mentioning that the case fatality rate in the study population was 9%, which was quite high.…”

“…Epilepsy is a common chronic neurological disorder, second only to cerebrovascular disease and dementia, and its incidence is higher in the elderly than in any other age group 3 . Long LOS is common among patients with epilepsy, particularly in the elderly who experience early seizure recurrence and who suffer from status epilepticus (SE), and it is associated with hospital mortality and excessive healthcare spending 4,5,6,7 . Although especially common in the elderly, long LOS can be prevented 8 .…”

Health care expenditures among elderly patients with epilepsy in the United States

“…The use of ICD‐9‐CM codes 345.xx and 780.39 was endorsed and validated by the International League Against Epilepsy for epidemiologic studies and surveillance of epilepsy . ICD‐9 codes 345.xx and 780.3x have been used to ascertain cases of epilepsy in prior epidemiological studies on epilepsy . The 12‐year data have a common variance structure necessary to ensure compatibility and comparability of variables within the sample design .…”

“…11,13 ICD-9 codes 345.xx and 780.3x have been used to ascertain cases of epilepsy in prior epidemiological studies on epilepsy. [14][15][16] The 12-year data have a common variance structure necessary to ensure compatibility and comparability of variables within the sample design. 10 We divided the analytic sample by the number of years being pooled to adjust the analytic sampling weight variable.…”

Direct-Acting Oral Anticoagulants and Antiseizure Medications for Atrial Fibrillation and Epilepsy and Risk of Thromboembolic Events

“…Estimates suggest that OACs are coprescribed to as many as 1 in 10 ASM-using adults with epilepsy . This high prevalence of drug concomitancy is indication based, given the frequent concurrency of and association between epilepsy and atrial fibrillation (AF) (as well as other core indications for DOACs) . However, EI ASMs induce permeability glycoprotein efflux transporter protein (which is involved in intestinal absorption and renal elimination of DOACs) and/or cytochrome p450 3A4 (CYP3A4; which is involved in metabolism of select DOACs) .…”