Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Abstract

BackgroundEarly identification of patients with a prolonged stay due to acute exacerbation of chronic obstructive pulmonary disease (COPD) may reduce risk of adverse event and treatment costs. This study aimed to identify predictors of prolonged stay after acute exacerbation of COPD based on variables on admission; the study also looked to establish a prediction model for length of stay (LOS).MethodsWe extracted demographic and clinical data from the medical records of 599 patients discharged after an acute exacerbation of COPD between March 2006 and December 2008 at Oslo University Hospital, Aker. We used logistic regression analyses to assess predictors of a length of stay above the 75th percentile and assessed the area under the receiving operating characteristic curve to evaluate the model’s performance.ResultsWe included 590 patients (54% women) aged 73.2±10.8 years (mean ± standard deviation) in the analyses. Median LOS was 6.0 days (interquartile range [IQR] 3.5–11.0). In multivariate analysis, admission between Thursday and Saturday (odds ratio [OR] 2.24 [95% CI 1.60–3.51], P<0.001), heart failure (OR 2.26, 95% CI 1.34–3.80), diabetes (OR 1.90, 95% CI 1.07–3.37), stroke (OR 1.83, 95% CI 1.04–3.21), high arterial PCO2 (OR 1.26 [95% CI 1.13–1.41], P<0.001), and low serum albumin level (OR 0.92 [95% CI 0.87–0.97], P=0.001) were associated with a LOS >11 days. The statistical model had an area under the receiver operating characteristic curve of 0.73.ConclusionAdmission between Thursday and Saturday, heart failure, diabetes, stroke, high arterial PCO2, and low serum albumin level were associated with a prolonged LOS. These findings may help physicians to identify patients that will need a prolonged LOS in the early stages of admission. However, the predictive model exhibited suboptimal performance and hence is not ready for clinical use.

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

“…Our data are consistent with another report in the literature showing that pCO 2 independently predicts prolonged hospital stay [4]. This suggests that respiratory failure is more common in the long LoS group.…”

“…Co-morbidities were common in both groups, particularly heart failure, but also ischemic heart disease and other vascular disease (data not shown). Heart failure has been shown to be a strong independent predictor for a long LoS after a COPD exacerbation [4], and a high degree of co-morbidity, as shown by the Charlson Index, correlates with LoS [5,17] in other studies. There was a trend for heart failure being slightly more prevalent in the long LoS group in this study, although this did not reach statistical significance (p=0.14).…”

“…The best way for hospitals to mitigate against such discharge difficulties may be to ensure their workforce is intimately familiar with the local and national discharge process but also to strive for timely discharge-related decision making and ever more effective communication with community services, patients, and next-of-kin [29]. Current evidence is that being admitted over a weekend predicts prolonged hospital stay [4]. This is probably due to a number of factors including reduced weekend clinical decision making and reduced assessments for and provision of social care.…”

“…A British Thoracic Society study found a mean value of 7.1 days, whereas in Norway, it was 8.9 days, and a study in Blackpool reported 9.8 days [3][4][5]. Importantly, there is significant variation across England and Wales between many aspects of service provision and clinical outcomes for patients with respiratory disease.…”

Prolonged Hospitalisation in Patients Admitted With Acute Exacerbation of Copdprevalence and Its Predictors

“…This was comparable with study by Zinka Matkovic et al in which 84% were male and 16% were female. 6 Proportion of female patients were around 50% in various other studies of Ying Wang et al, Yan Ching et al 7,8 This difference may be due to the differences in smoking habits between the population. Around 90% of the patients had either Grade 2 or Grade 3 MMRC dyspnoea in stable state.…”