Dataset Information

Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.

ABSTRACT:

Background

OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.

Methods

We carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment, and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.

Results

Of the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 years vs 72 years), more likely to be men (53% vs 46%), more likely to be married (46% vs 38%), and had a higher prevalence of obesity (38% vs 6%), chronic pulmonary disease (68% vs 47%), and heart failure (28% vs 19%). Patients with OSA were more likely to receive invasive (18.1% vs 9.3%) and noninvasive (28.8% vs 6.8%) forms of ventilation upon hospital admission. After multivariable adjustment, OSA was associated with an increased risk of transfer to intensive care (OR, 1.54; 95% CI, 1.42-1.68) and intubation (OR, 1.68; 95% CI, 1.55-1.81) on or after the third hospital day, longer hospital stays (risk ratio [RR], 1.14; 95% CI, 1.13-1.15), and higher costs (RR, 1.22; 95% CI, 1.21-1.23) among survivors, but lower mortality (OR, 0.90; 95% CI, 0.84-0.98).

Conclusion

Among patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration, and higher resource use, yet a modestly lower risk of inpatient mortality.

SUBMITTER: Lindenauer PK

PROVIDER: S-EPMC4011652 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Publications

Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.

Lindenauer Peter K PK Stefan Mihaela S MS Johnson Karin G KG Priya Aruna A Pekow Penelope S PS Rothberg Michael B MB

Chest 20140501 5

<h4>Background</h4>OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.<h4>Methods</h4>We carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment, and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.<h4>Result ...[more]

PMID: 24371839

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Project description:ImportanceAntibiotics are frequently prescribed for suspected pneumonia, but overdiagnosis is common and fixed regimens are often used despite randomized trials suggesting it is safe to stop antibiotics once clinical signs are normalizing.ObjectiveTo quantify potential excess antibiotic prescribing by characterizing antibiotic use relative to patients' initial clinical signs and subsequent trajectories.Design, setting, and participantsAn observational cohort study was conducted in 2 tertiary and 2 community hospitals in Eastern Massachusetts. All nonventilated adult patients admitted between May 1, 2017, and July 1, 2018 (194 521 hospitalizations), were included.Main outcomes and measuresIdentification of all antibiotic starts for possible community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) per clinicians' stated indications. Potential excess antibiotic prescribing was quantified by characterizing the frequency of patients in whom all clinical signs were within reference ranges on the first day of antibiotic therapy and by how long antibiotic therapy was continued after all clinical signs were normal, including postdischarge antibiotics.ResultsAmong 194 521 hospitalizations, 9540 patients were treated for possible CAP (4574 [48.0%] women; mean [SD] age, 67.6 [17.0] years) and 2733 for possible HAP (1211 [44.3%] women; mean [SD] age, 66.7 [16.2] years). Temperature, respiratory rate, oxygen saturation, and white blood cell count were all within reference ranges on the first day of antibiotics in 1779 of 9540 (18.6%) episodes of CAP and 370 of 2733 (13.5%) episodes of HAP. Antibiotics were continued for 3 days or longer after all clinical signs were normal in 3322 of 9540 (34.8%) episodes of CAP and 1050 of 2733 (38.4%) episodes of HAP. Up to 24 978 of 71 706 (34.8%) antibiotic-days prescribed for possible pneumonia may have been unnecessary.Conclusions and relevanceIn this study, almost one-fifth of hospitalized patients treated for pneumonia did not have any of the cardinal signs of pneumonia on the first day of treatment and antibiotics were continued for 3 days or longer after all signs were normal in more than a third of patients. These observations suggest substantial opportunities to improve antibiotic prescribing.

Dataset Information

Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.

Background

Methods

Results

Conclusion

Publications

Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.

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