Dataset Information

Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.

ABSTRACT:

Background

Various studies have tried to delimit the predictors of hospital length of stay (LOS) for patients with exacerbated chronic obstructive pulmonary disease (eCOPD), but have been disadvantaged by certain limiting factors.

Objective

Our goal was to prospectively identify predictors of LOS in these patients and to validate our results.

Design

This was a prospective cohort study.

Participants

Subjects were patients with eCOPD who visited 16 hospital emergency departments (EDs) and who were admitted to the hospital.

Main measures

Data were recorded on possible predictor variables at the ED visit, on admission and 24 hours later, during hospitalization, and on discharge. LOS and prolonged LOS (? 9 days, considering the 75th percentile of LOS in our sample) were the outcomes of interest. Multivariate multilevel linear and logistic regression models were employed.

Results

A total of 1,453 patients were equally divided between derivation and validation samples. The hospital variable was the best predictor of LOS. Multivariate predictors of LOS, as log-transformed variables, were the hospital, baseline dyspnea and physical activity levels and fatigue at 24 hours, intensive care or intensive respiratory care unit admission, the need for antibiotics, and complications during hospitalization. Predictors of prolonged LOS were also the hospital, baseline dyspnea and fatigue at 24 hours, ICU or IRCU admission, and complications during hospitalization (AUC: 0.77). Models were validated in the validation sample (AUC: 0.75).

Conclusions

We identified a number of modifiable factors, including baseline dyspnea, physical activity level, and hospital variability, that influenced the LOS of patients with eCOPD who were admitted to the hospital.

SUBMITTER: Quintana JM

PROVIDER: S-EPMC4441653 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.

Quintana José M JM Unzurrunzaga Anette A Garcia-Gutierrez Susana S Gonzalez Nerea N Lafuente Iratxe I Bare Marisa M de Larrea Nerea Fernandez NF Rivas Francisco F Esteban Cristóbal C

Journal of general internal medicine 20141204 6

<h4>Background</h4>Various studies have tried to delimit the predictors of hospital length of stay (LOS) for patients with exacerbated chronic obstructive pulmonary disease (eCOPD), but have been disadvantaged by certain limiting factors.<h4>Objective</h4>Our goal was to prospectively identify predictors of LOS in these patients and to validate our results.<h4>Design</h4>This was a prospective cohort study.<h4>Participants</h4>Subjects were patients with eCOPD who visited 16 hospital emergency d ...[more]

PMID: 25472508

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Project description:BACKGROUND:Failure in the timely follow-up of test results has been widely documented, contributing to delayed medical care. Yet, the impact of delay in reviewing test results on hospital length of stay (LOS) has not been studied. We examine the relationship between laboratory tests review time and hospital LOS. METHODS:A retrospective cohort study of inpatients admitted to a metropolitan teaching hospital in Sydney, Australia, between 2011 and 2012 (n = 5804). Generalized linear models were developed to examine the relationship between hospital LOS and cumulative clinician read time (CRT), defined as the time taken by clinicians to review laboratory test results performed during an inpatient stay after they were reported in the computerized test reporting system. The models were adjusted for patients' age, sex, and disease severity (measured by the Charlson Comorbidity index), the number of test panels performed, the number of unreviewed tests pre-discharge, and the cumulative laboratory turnaround time (LTAT) of tests performed during an inpatient stay. RESULTS:Cumulative CRT is significantly associated with prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of prolonged LOS by 13.2% (p < 0.0001). Restricting the analysis to tests with abnormal results strengthened the relationship between cumulative CRT and prolonged LOS, with each day of delay in reviewing test results increasing the likelihood of delayed discharge by 33.6% (p < 0.0001). Increasing age, disease severity and total number of tests were also significantly associated with prolonged LOS. Increasing number of unreviewed tests was negatively associated with prolonged LOS. CONCLUSIONS:Reducing unnecessary hospital LOS has become a critical health policy goal as healthcare costs escalate. Preventing delay in reviewing test results represents an important opportunity to address potentially avoidable hospital stays and unnecessary resource utilization.

Project description:BACKGROUND:In COPD, the course of the disease including morbidity and mortality is strongly associated with severe exacerbations. The current GOLD recommendations emphasize blood eosinophil counts as a marker for responsiveness to inhaled corticosteroids (ICS). Retrospective analyses from randomized clinical trials indicate a favorable response to systemic corticosteroids in exacerbated COPD patients with blood eosinophils >?2%, however data outside clinical trials are scarce. PATIENTS AND METHODS:We retrospectively evaluated data from 1007 cases of patients who were admitted to the University Medical Center Marburg between 01/2013 and 12/2018. All patients had been diagnosed with an acute exacerbation of COPD (ICD-10?J44.0/J44.1). Our analysis was based on a subgroup of 417 patients in whom a full blood cell count was obtained at the day of admission. Patients were predominantly male (63.3%), had a median age of 74 years (IQR 65 years - 83 years) and a median FEV1 of 1.03 l (42.6% predicted). We compared the hospital length of stay and other outcome parameters using established thresholds for the eosinophil blood cell count (100 and 300 eosinophils/?l and 2%). RESULTS:Patients with low eosinophils (<?2%, <100 cells/?l) had a longer median time in hospital (length of hospital stay - LOS) as compared to patients with high eosinophils (<?2%: 9.31 vs. ?2%:7?days, and?<?100/?l: 10 vs. 100-300/?l: 8 vs. >?300/?l: 7?days). The median CRP was higher in patients with low eosinophils as compared to the other groups (<?2%: 22.7 vs. ?2%: 9?mg/dl and?<?100: 25 vs. 100-300: 13.5 vs. >?300: 7.1?mg/dl). Time to re-hospitalization or time to death did not differ between strata of eosinophils. Sensitivity analysis in a subgroup of patients in which pneumonia was excluded by chest x-ray did not significantly alter the results. CONCLUSION:The results support the hypothesis that patients with severe COPD exacerbations and elevated blood eosinophil counts respond better to systemic corticosteroid treatment than patients with a non-eosinophilic exacerbation.

Dataset Information

Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.

Background

Objective

Design

Participants

Main measures

Results

Conclusions

Publications

Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study.

Similar Datasets

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