Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan

Hiromi Nishi; Mikihito Kajiya; Kouji Ohta; Hideo Shigeishi; Taiji Obayashi; Syuichi Munenaga; Nami Obayashi; Yukio Yoshioka; Masaru Konishi; Takako Naruse; Akihiro Matsumoto; Ayaka Odo; Masae Kitagawa; Toshinori Ando; Tomoaki Shintani; Tomoko Tokikazu; Natsumi Ino; Naoki Mihara; Naoya Kakimoto; Kazuhiro Tsuga; Kotaro Tanimoto; Hiroki Ohge; Hidemi Kurihara; Hiroyuki Kawaguchi

doi:10.1038/s41598-024-60733-z

Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan

Sci Rep. 2024 May 15;14(1):11114. doi: 10.1038/s41598-024-60733-z.

Authors

Hiromi Nishi¹, Mikihito Kajiya^{2

3}, Kouji Ohta⁴, Hideo Shigeishi⁴, Taiji Obayashi⁵, Syuichi Munenaga⁶, Nami Obayashi^{6

3}, Yukio Yoshioka⁷, Masaru Konishi⁸, Takako Naruse⁹, Akihiro Matsumoto¹⁰, Ayaka Odo¹¹, Masae Kitagawa^{3

12}, Toshinori Ando^{3

12}, Tomoaki Shintani³, Tomoko Tokikazu¹³, Natsumi Ino¹³, Naoki Mihara¹⁰, Naoya Kakimoto¹⁴, Kazuhiro Tsuga¹⁵, Kotaro Tanimoto¹¹, Hiroki Ohge¹⁶, Hidemi Kurihara¹⁷, Hiroyuki Kawaguchi⁶

Affiliations

¹ Department of General Dentistry, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan. hiyoko@hiroshima-u.ac.jp.
² Department of Innovation and Precision Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
³ Department of Oral Laboratory Center, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Department of Public Oral Health, Program of Oral Health Sciences, Hiroshima University, Hiroshima, Japan.
⁵ Department of Dental Hygiene, Ogaki Women's College, Gifu, Japan.
⁶ Department of General Dentistry, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
⁷ Department of Oral Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan.
⁸ Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan.
⁹ Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹⁰ Department of Medical Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹¹ Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹² Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹³ Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan.
¹⁴ Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹⁵ Department of Advanced Prosthodontics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
¹⁶ Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
¹⁷ Dental Academy at Kudamatsu, Yamaguchi, Japan.

Abstract

Oral bacteria are known to be associated with perioperative complications during hospitalization. However, no presented reports have clarified the relationship of oral bacterial number with medical costs for inpatients. The Diagnosis Procedure Combination (DPC) database system used in Japan provides clinical information regarding acute hospital patients. The present study was conducted to determine the association of oral bacterial numbers in individual patients treated at a single institution with length of hospital stay and medical costs using DPC data. A total of 2369 patients referred by the medical department to the dental department at Hiroshima University Hospital were divided into the low (n = 2060) and high (n = 309) oral bacterial number groups. Length of hospital stay and medical costs were compared between the groups, as well as the associations of number of oral bacteria with Charlson comorbidity index (CCI)-related diseases in regard to mortality and disease severity. There was no significant difference in hospital stay length between the low (24.3 ± 24.2 days) and high (22.8 ± 20.1 days) oral bacterial number groups. On the other hand, the daily hospital medical cost in the high group was significantly greater (US$1456.2 ± 1505.7 vs. US$1185.7 ± 1128.6, P < 0.001). Additionally, there was no significant difference in CCI score between the groups, whereas the daily hospital medical costs for patients in the high group treated for cardiovascular disease or malignant tumors were greater than in the low number group (P < 0.05). Multivariate regression analysis was also performed, which showed that oral bacterial number, age, gender, BMI, cardiovascular disease, diabetes, malignant tumor, and hospital stay length were independently associated with daily hospitalization costs. Monitoring and oral care treatment to lower the number of oral bacteria in patients affected by cardiovascular disease or cancer may contribute to reduce hospitalization costs.

Keywords: Hospitalization cost; Oral bacterial number.

MeSH terms

Adult
Aged
Aged, 80 and over
Bacteria / classification
Bacteria / isolation & purification
Bacterial Load
Databases, Factual
Female
Health Care Costs
Hospital Costs
Hospitalization* / economics
Humans
Japan / epidemiology
Length of Stay* / economics
Male
Middle Aged
Mouth / microbiology

Grants and funding

20K10162/research grant from JSPS KAKENHI