Disparities in Palliative Care Services Among Critically-ill Necrotizing Fascitis Patients

Author(s):
Amir Sohail; Samia Sulaiman; Abu baker Sheikh; Goyal Aman

Background:

Necrotizing fasciitis (NF) and sepsis shock (SS) are both severe and life-threatening conditions requiring specialized care, including palliative care (PC), to optimize comfort. However, data on utilization of PC in this population, including racial and gender disparities are limited.

Hypothesis:

We hypothesized that there was lower utilization of PC among racial minorities and men

Methods:

We used the National Inpatient Sample (NIS) database from 2016-2020 to extract data on patients with NF and SS as well as PC utilization. Chi-squared tests and multivariate linear regression models were utilized to analyze relationships between categorical and continuous variables, respectively. Multivariate logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) for various outcomes among various gender and racial groups. Mann-Kendall trend test was used to assess mortality trends over time.

Results:

Among the 11,260 patients with NF and SS, 2,645 received PC while 8,615 did not. Female patients had significantly higher odds of receiving PC versus males (OR 1.42, 95% CI 1.27-1.58). No significant racial disparities in PC utilization were observed. Patients receiving PC had higher odds of in-hospital mortality (OR 1.18, 95% CI 1.03-1.35). No significant trend in in-hospital deaths was observed over the study period. PC was associated with significantly shorter length-of-stay and lower costs.

Conclusions:

Our  study provides comprehensive insights, and identifies gender disparities in PC utilization in NF and SS patients. Further research must aim to refine delivery strategies and address potential disparities in PC.