SEDATIVE-HYPNOTIC USE AND INCREASED HOSPITAL STAY AND COSTS IN OLDER-PEOPLE

OBJECTIVE: To assess the relationship between sedative-hypnotic (S/H) utilization, severity of illness, length of stay, and hospital costs a mong older patients admitted to a tertiary care university hospital. D ESIGN: Retrospective review of computerized hospital and pharmacy data bases.SUBJECTS: A total of 856 older consecutive medical and surgical admissions from November 1993 to March 1994. MEASUREMENTS: Sedative/h ypnotic utilization in accord with the Health Care Financing Administr ation (HCFA) guidelines for S/H use in nursing homes. Jefferson Diseas e Staging to estimate severity of illness. Hospital records to obtain demographic characteristics, length of stay, and hospital costs. RESUL TS: Patients whose SM use exceeded HCFA guidelines, compared with thos e within the guidelines and those receiving no drugs, had longer lengt hs of stay (21.5 days vs 12.3 days vs 6.7 days, P < .001), increased h ospital costs ($29,245 vs $15,219 vs $7,516, P < .001), and greater se verity of illness (245.8 vs 189.5 vs 148.5, P < .001). S/H use exceedi ng and within HCFA guidelines were associated with increased length of stay (both P < .0001) and hospital costs (both P < .0001). CONCLUSION S: Older hospitalized patients receiving S/H have greater severity of illness, longer lengths of stay, and higher hospital costs compared wi th other patients. S/H use, and, in particular, S/H use exceeding the HCFA guidelines, are associated with increased hospital stay and cost.