title: The impact of comorbidities on inpatient Charcot neuroarthropathy cost and utilization.
abstract: OBJECTIVE
  The purpose of this study was to portray the impact of comorbidities on inpatient cost and utilization in Charcot neuroarthropathy (CN) patients.
  
  
  METHODS
  Two cohorts, CN and diabetic peripheral neuropathy (DPN), were identified by ICD-9 codes in the California Office for Statewide Health Planning and Development 2009-2012 public patient discharge files. DPN and CN costs and length of stay (LOS) were compared adjusting for the number of chronic conditions. The impact of the Elixhauser comorbidity measures and other comorbidities on costs and LOS in CN subjects was evaluated.
  
  
  RESULTS
  CN was associated with 17.2% higher costs and 1.4 days longer LOS compared to DPN alone. Adjusting for 0.71 additional chronic conditions in CN patients accounted for 79.8% of variance and estimated a 13.9% cost difference between cohorts. Subjects averaged 4.5 Elixhauser comorbidities with higher scores corresponding to increased cost, LOS, and inpatient mortality. Other diabetic foot risk factors demonstrated that foot ulcers, foot infections, and osteomyelitis had significantly higher costs. Patients with foot ulcers, osteomyelitis, and depression had significantly increased LOS.
  
  
  CONCLUSIONS
  Systemic and local comorbidities significantly impact the cost, utilization, and inpatient mortality in inpatient management of Charcot foot.
authors: College of Podiatric Medicine, Western University of Health Sciences, 309 E Second Street, Pomona, CA 91766. Electronic address: jlabovitz@westernu.edu.
authors: Jonathan M
authors: JM
authors: Labovitz
authors: College of Podiatric Medicine, Western University of Health Sciences, 309 E Second Street, Pomona, CA 91766. Electronic address: dshofler@westernu.edu.
authors: David W
authors: DW
authors: Shofler
authors: College of Podiatric Medicine, Western University of Health Sciences, 309 E Second Street, Pomona, CA 91766. Electronic address: kragothaman@westernu.edu.
authors: Kevin K
authors: KK
authors: Ragothaman
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D002607:Charcot-Marie-Tooth Disease / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003929:Diabetic Neuropathies / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D019456:Health Transition; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063886:Patient Discharge Summaries; D012189:Retrospective Studies; D012307:Risk Factors; D014600:Utilization Review
keywords: Charcot neuroarthropathy; Comorbidities; Costs; Healthcare utilization; Lenght of stay