MON-483 - Nationwide Hospitalization Outcomes and Resource Utilization in Adrenal Insufficiency and Addisonian Crisis: A 2022 NIS Analysis

Background
Adrenal insufficiency is a rare but clinically significant endocrine disorder, and Addisonian crisis represents its most severe and potentially life-threatening presentation. Contemporary nationwide data describing hospitalization patterns, outcomes, and resource utilization associated with adrenal insufficiency and Addisonian crisis in the United States remain limited.

Methods
We performed a retrospective cross-sectional analysis of the 2022 Nationwide Inpatient Sample (NIS), identifying adult hospitalizations with a primary diagnosis of adrenal insufficiency using ICD-10-CM codes E27.1–E27.4. Addisonian crisis was defined as a primary diagnosis of E27.2. National estimates were generated using discharge weights to account for the NIS survey design. Outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges. Survey-weighted multivariable logistic regression was used to assess mortality, while log-linear regression models were used for LOS and charges, adjusting for age, sex, race, primary payer, and ZIP-code–level income quartile.

Results
In 2022, an estimated 9,130 hospitalizations for primary adrenal insufficiency occurred nationally. Among unweighted admissions (n=1,826), the mean age was 58.4 years, and 58.1% were female. Most patients were White (70.3%), followed by Black (13.3%) and Hispanic (10.5%). Medicare was the most common primary payer (51.4%), and over half of admissions originated from the two lowest income quartiles.
Addisonian crisis accounted for 33.6% of adrenal insufficiency admissions. Overall, in-hospital mortality was 0.82% (95% CI 0.50–1.36). Mean LOS was 5.22 days, and total hospitalization charges were $54,593. In unadjusted analyses, crisis admissions were associated with shorter LOS (4.59 vs. 5.53 days) and lower charges ($46,770 vs. $58,361) compared with non-crisis admissions.
After multivariable adjustment, Addisonian crisis was not associated with increased in-hospital mortality (adjusted odds ratio 0.84, 95% CI 0.26–2.71). However, crisis admissions were independently associated with shorter LOS (adjusted −10.4%, 95% CI −17.4% to −2.8%; p=0.008) and lower hospitalization charges (adjusted −19.6%, 95% CI −26.6% to −11.9%; p< 0.001).

Conclusions
In a contemporary nationwide cohort, Addisonian crisis accounted for one-third of adrenal insufficiency hospitalizations and was not associated with increased in-hospital mortality. Crisis admissions were independently associated with shorter hospital stays and lower costs, suggesting that prompt recognition and standardized inpatient management may improve efficiency without compromising patient outcomes.

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