Report: Vision-Impaired Hospital In-Patients Have Poorer Outcomes, Use More Resources

Patients with severe vision impairment or blindness have worse clinical outcomes and use more resources when hospitalized in the US than patients who don’t have vision issues, according to research published in BMC Ophthalmology. Hospital-based healthcare providers should be aware of this disparity and take steps to better serve this group of patients, according to investigators.

Researchers suspect that the percentage of Americans with vision impairment or blindness will increase as the population ages. As such, hospital providers in all specialties will likely become progressively more involved in their care. 

According to researchers, outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. And, because obesity is common among hospitalized patients, it is important to understand obesity’s effect on patients with severe vision impairment or blindness.

Investigators conducted a retrospective study using the National Inpatient Sample for 2017. In the sample, 30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4±0.24 vs 57.9±0.09 years, P <.01), less likely to be women (50% vs 57.7%, P <.01), more frequently insured by Medicare (75.7% vs 49.2%, P <.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2% vs 27.8%, P <.01). 

Researchers found that patients with SVI/B had a higher in-hospital mortality rate (3.9% vs 2.2%; P <.01), and had lower odds to be discharged home after hospital discharge (P <.01) compared with patients without SVI/B. 

Regarding resource use, researchers found that hospital charges were not significantly different between the groups (P =.85) but length of stay was longer (aMD = 0.5 days CI [0.3–0.7]; P <.01) for those with SVI/B. Patients with vision impairment who also were obese had higher total hospital charges compared with those who were not obese (mean difference: $9,821 [CI $1,375-$18,268]; P =.02).

This study’s limitations included that the data used depended on coding imputations and lacked detailed information about visual testing results, lab data, imaging reports, and medications. Additionally, influences on diagnostic or treatment decisions can not be determined, and disease severity and measurements documenting clinical status throughout the hospitalization were not captured. Lastly, as per the study’s design, there may be unmeasured and unknown confounders that influenced outcomes. 

Reference

Harris, CM, Wright SM. Severe vision impairment and blindness in hospitalized patients: a retrospective nationwide study. BMC Ophthalmol. Published online June 22, 2021. doi:10.1186/s12886-021-02021-2