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Introduction Despite availability of rapid TB diagnostics and referral pathways, hospitalisation rates for TB remain high across Europe, contributing significantly to TB treatment costs. 1 While several European countries have published data on TB hospitalisation costs,2 such data is lacking for the UK.Objectives To quantify the proportion of TB cases hospitalised, assess average length of stay (ALOS), identify factors influencing hospitalisation and ALOS, and estimate the proportion of potentially avoidable admissions in Leicester. Method This was a retrospective cohort study of all TB patients admitted between Jan-Dec 2023. The World Health Organization (WHO) criteria for hospitalisation guided selection of corresponding locally-recorded factors (table 1). Turnaround times (TAT) along the care cascade (time to sampling, results, treatment initiation and discharge) were extracted from patient records.Result Table 1 Of 199 TB cases notified, 67 (33.7%) were hospitalised contributing 74 discrete hospitalisation episodes - 15 (22%) patients had pulmonary TB, 11 (16%) extrapulmonary TB, and 41 (61%) multi-compartmental disease. Four patients (5.9%) died.Key hospitalisation factors identified were disease severity (31%), co-morbidities (36%), and malnutrition (34%). Thirteen patients (19%) had 1 factor for hospitalisation, 40 patients (60%) had >1 factors, while 14 (21%) had no identifiable factors. The ALOS was 33 days (median 21, IQR 11–37), comprising a median TAT from admission to diagnostic result of 9 days, and 13 days from starting treatment to discharge. For diagnosis, Xpert-Ultra MTB-RIF was used in 61 patients (91%) and 54 (81%) tested positive. Median length of stay was unaffected by the number of hospitalisation factors (19–21 days across groups with 0, 1 and >1 factor identified), suggesting predominance of operational factors.Abstract M43 Table 1WHO* and local TB hospitalization criteria Main Criteria Corresponding variables collected at Leicester Number of patients meeting criterion Severe TB- Meningitis, vertebral bone TB, Pericarditis, Miliary TB, Severe lung disease( Respiratory distress/failure, sepsisDisease type (no change)NEWSSevere TB-21(31%)NEWS->/=7-10(15%) Complications of TB-requiring surgical interventions, such as haemorrhage, pneumothorax and pleural effusionProcedure done (Y/N)Procedure done-15(22%) Serious comorbidities with TB-Severe Malnutrition, untreated HIV, liver disease, renal disease and Uncontrolled DiabetesDiabetesCancerHIV (new / high viral load)CKD eGFR<30 / AKI 1MUST score >/=2Clinical Frailty Score >/=5Rest of co-morbidities/coinfection-24(36%)MUST Score-23(34%)CSF Score-7(10%) Extreme of age-Very young or old <5 years and >65No change10(15%) Life-threatening and serious medical events resulting from adverse reactions to anti-TB drugs (e.g. life-threatening arrhythmias, psychosis, renal failure and hearing lossInterruption to medication due to adverse effects10(15%) Additional Criteria 1)Patients for whom effective and safe anti-TB treatment cannot be ensured in an outpatient, community or home setting (i.e. homelessness, overcrowding, exposure of children aged <5 years and pregnant women in the household)2)When there are accessibility problems (i.e. patient lives far from an outpatient facility3)Where there is nonadherence to treatment (this can be considered in some settings as a last resort once all other care options have been used/applied exhaustively, based on the legal framework in force)Social Risk Factors11(16%)*Source: WHO Operational Handbook on TB 2022; Consensus Document of WHO Regional Office EuropeConclusion In 2023, one-third of TB patients in Leicester were hospitalised, with ALOS exceeding 30 days - longer than in comparable European countries like Sweden or the Netherlands (ALOS <20days) with similar hospitalisation rates. 2 One-fifth of admissions were potentially avoidable as no factor for admission could be identified, while in-patient TATs were prolonged despite use of molecular diagnostics. We conclude TB-healthcare costs may be significantly reduced by developing strategies to prevent unnecessary admission and streamlining inpatient pathways.References PMID:33547028PMID:23949960