Association of concurrent COVID-19 infection with in-hospital outcomes among patients hospitalized for head and neck cancer.

Abstract

e18132 Background: Patients with head and neck cancer (HNC) often have substantial comorbidity and may be particularly vulnerable to adverse outcomes when hospitalized with COVID-19. National data examining inpatient complications, mortality, healthcare utilization, and socioeconomic disparities in this population remain limited. Methods: We conducted a retrospective, survey-weighted analysis of the National Inpatient Sample (2020–2022), identifying adult hospitalizations with a primary diagnosis of HNC. Admissions were stratified by concurrent COVID-19 infection. Demographics, comorbidities, socioeconomic factors, and in-hospital outcomes were compared. Unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: An estimated 77,960 hospitalizations for HNC without COVID-19 and 840 with concurrent COVID-19 were identified. Mean age was similar between groups (64.1 vs 64.0 years), and most patients were male. COVID-positive HNC patients were more likely to be insured by Medicaid and to reside in lower-income areas, and had greater comorbidity burden (mean Elixhauser Comorbidity Index 4.83 vs 4.08; p <0.001). Concurrent COVID-19 infection was associated with higher odds of acute kidney injury (OR 3.02, 95% CI 2.31–3.95), sepsis (OR 2.51, 95% CI 1.71–3.69), pneumonia (OR 2.15, 95% CI 1.56–2.95), mechanical ventilation (OR 1.94, 95% CI 1.42–2.66), vasopressor use (OR 2.04, 95% CI 1.28–3.24), and cardiac arrest (OR 2.84, 95% CI 1.41–5.73). In-hospital mortality was higher among COVID-positive admissions (8.9%), with nearly fourfold increased odds of death (OR 3.81, 95% CI 2.88–5.03). COVID-positive hospitalizations also had longer mean length of stay (11.2 vs 6.8 days) and higher mean charges ($157,618 vs $130,717; p <0.001). Conclusions: Among patients hospitalized primarily for HNC, concurrent COVID-19 infection was associated with increased risk of severe in-hospital complications, higher mortality, and greater healthcare utilization, disproportionately affecting socioeconomically disadvantaged patients. In-hospital complications and mortality associated with concurrent COVID-19 in patients hospitalized for head and neck cancer. Outcome Without COVID-19 With COVID-19 Odds Ratio In-hospital mortality 2.51 % 8.93% 3.81 (95% CI 2.88–5.03) Acute kidney Injury 6.98 % 18.45% 3.02 (95% CI 2.31–3.95) Sepsis 3.23% 7.74% 2.51 (95% CI 1.71–3.69) Pneumonia 4.98% 10.12% 2.15 (95% CI 1.56–2.95) Mechanical Ventilation 6.16% 11.31% 1.94 (95% CI 1.42–2.66) Vasopressor Use 1.78% 3.57% 2.04 (95% CI 1.28–3.24) Cardiac Arrest 0.85% 2.38% 2.84 (95% CI 1.41–5.73)