Changing Inpatient Treatment Time—Does It Improve Outcome?

Factors other than the rate of weight gain during hospitalization may influence treatment outcome for patients with anorexia nervosa (AN), according to Scott J. Crow, MD, and Molly C. Gill, from the University of Minnesota, Minneapolis. They reported their study at the Academy for Eating Disorders meeting in Orlando.

According to the authors, over the last 20 years the length of inpatient hospitalization for eating disorders has decreased, as has the average weight at discharge. At the same time, the number of hospital re-admissions has increased. It has also been shown that when patients are discharged while still underweight, they may have a less favorable outcome.

Dr. Crow and colleagues attempted to replicate these findings and to examine characteristics of weight restoration that might affect treatment outcome during two separate periods. The subjects included all University of Minnesota Hospital first admissions for treatment of eating disorders during 1975 to 1980 and 1990 to 1995. The number of patients meeting DSM-IV criteria for AN admitted to the hospital during these two treatment periods was 23 and 97, respectively.

The researchers found that length of inpatient stay deceased significantly from the first time period to the second: from 70 days to 37 days. During the same time, the likelihood of rehospitalization for treatment of an eating disorder increased significantly: from a 4% chance of readmission during the first time period to a 40% chance of readmission in the second time period.

Outcome is linked to rate of weight gain

Unlike previous studies, average admission weight increased significantly, from 77 lb to 88 lb, while the average discharge weight did not change significantly. During both study periods subjects were discharged while they were still underweight (average body mass indexes of 16.57 and 16.72 kg/m2, respectively). Thus, lower discharge weight could not account for the increase in hospital readmissions. There was, however, a significant difference in the rate of inpatient weight gain, from an average of 0.27 lb/day in the first group to an average of 0.43 lb/day in the second study group.

According to the authors, their study results suggest that outcome of hospitalization for AN is influenced not only by discharge weight, but by the rate of weight gain while the patient is hospitalized. Therefore, longer inpatient stays for patients with AN may lead to better outcomes and fewer readmissions.