S3121 Assessment of Healthcare Quality Metrics in Hospitalized Patients with Peptic Ulcer Disease on Bisphosphonate Therapy: An Analysis of the 2021 National Inpatient Sample

Introduction: Peptic ulcer disease (PUD) continues to contribute significantly to inpatient morbidity and mortality. While bisphosphonate use is a known risk factor for PUD, its impact on key healthcare quality metrics, specifically in-hospital mortality, length of hospital stay (LOS), and total hospital charges remains poorly defined. This study aimed to assess the association between bisphosphonate use and these healthcare quality outcomes among hospitalized PUD patients. Methods: We performed a retrospective cohort analysis using the 2021 National Inpatient Sample database. Among over 33 million hospitalizations, we identified 263,300 adult patients with a primary diagnosis of PUD. Of these, 1,575 patients (0.6%) were on bisphosphonate therapy. Multivariable logistic and Poisson regression models were used to evaluate associations between bisphosphonate use and in-hospital mortality, LOS, and total hospital charges, adjusting for demographics, and comorbidities. Results: Patients on bisphosphonate therapy were younger (mean age 55.6 vs 65.5 years; P < 0.001) and more frequently men (58.7% vs 46.0%; P < 0.001). After adjustment, bisphosphonate use was significantly associated with increased in-hospital mortality (odds ratio [OR] 4.39; 95% confidence interval [CI] 2.91-6.63; P < 0.001), shorter length of stay (6.6 vs 11.1 days; OR 0.60; 95% CI 0.54-0.67; P < 0.001), lower total hospital charges (<$50,000) (OR 0.49; 95% CI 0.42-0.58; P < 0.001). Bisphosphonate users also had lower prevalence of key comorbid conditions at baseline, including diabetes mellitus (23.5% vs 31.1%; P = 0.005), dyslipidemia (23.5% vs 49.1%; P < 0.001), and chronic obstructive pulmonary disease (9.8% vs 22.3%; P < 0.001). Conclusion: In this national analysis, bisphosphonate use among hospitalized PUD patients was paradoxically associated with both increased in-hospital mortality and improved efficiency metrics, including reduced LOS and hospital costs. One potential explanation is that higher mortality in this group may have contributed to reduced resource utilization due to shorter hospitalizations among patients who died despite having lower prevalence of comorbidities at baseline. These findings highlight a complex interplay between medication-associated risk and healthcare resource utilization, underscoring the need for further investigation into the drivers of these outcomes to optimize quality of care for this vulnerable patient population.