Breakpoint Analyses of the Effects of Sedative Use on Length of Stay and Costs in Chronic Disease Hospitalizations.

BACKGROUND

Sedatives, a class of psychotropic medications widely prescribed to hospitalized patients, offer various therapeutic benefits. However, inappropriate use can result in significant adverse effects. This study aims to investigate potential breakpoints of sedative use, hospital stays, and associated costs.

METHODS

Data were extracted from a hospital information system, including 13 822 eligible hospitalizations involving chronic disease treatment with sedative prescriptions from 2016 to 2023. Sedative dosages were standardized to diazepam equivalents using defined daily dosages (DDDs). Generalized additive models (GAMs) were used to examine nonlinear associations of sedative DDDs with length of stay (LOS) and hospital costs. Breakpoints in these associations were further estimated using segmented regressions.

RESULTS

In the total sample, the median DDD of sedatives was 1.00 (interquartile range: 0.62, 1.69). Segmented regressions estimated breakpoints at 0.83 DDD (95% CI: 0.82, 0.84) for LOS and 0.81 DDD (95% CI: 0.80, 0.83) for hospital costs. Below these DDD breakpoints, GAMs results estimated that an increase of 0.1 units in DDD was associated with a 5.5% decrease in LOS and a 6% decrease in hospital costs, respectively. It was predicted that reaching these breakpoints was associated with a 7.8% reduction in LOS and a 6.8% reduction in hospital costs for DDD values below these thresholds.

CONCLUSIONS

Our findings suggest that the rational use of sedatives below specific cutoff values was associated with a significant reduction in hospitalization burden among patients with chronic diseases.