Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Rothberg, Michael B.; Pekow, Penelope S.; Lahti, Maureen; Brody, Oren; Skiest, Daniel J.; Lindenauer, Peter K.

doi:10.1001/jama.2010.672

Cited by 177 publications

(116 citation statements)

References 23 publications

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“…Data are collected electronically from these sites, are audited regularly to ensure validity, and the database has been used extensively in outcomes research (18)(19)(20). In addition to the information contained in the standard hospital discharge abstract (i.e., UB-04), the database contains a datestamped log of all items and services charged to patients or their insurers, …”

Section: Design Setting and Subjectsmentioning

confidence: 99%

Hospital Patterns of Mechanical Ventilation for Patients with Exacerbations of COPD

Lindenauer

Stefan

Shieh³

et al. 2015

Annals ATS

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Rationale: Randomized trials have shown that noninvasive ventilation (NIV) can reduce the need for intubation and improve the survival of patients with severe exacerbations of chronic obstructive pulmonary disease (COPD); however, it is not known whether hospitals with greater use of NIV achieve lower rates of intubation and better patient outcomes. Measurements and Main Results:Using hierarchical modeling, we estimated hospital risk-standardized percentages of ventilator starts that were noninvasive (RS-NIV%). We examined the association between RS-NIV% and other outcomes, including risk-standardized rates of invasive ventilation and NIV failure, total ventilation, in-hospital mortality, length of stay, and costs. At the hospital level, the median RS-NIV% was 75.1% (range: 9.2-94.1%).Smaller hospitals and those located in rural areas had higher RS-NIV%. When stratified into quartiles on the basis of the RS-NIV%, hospitals in the highest quartile had lower riskstandardized rates of invasive mechanical ventilation (Q4 vs. Q1: 4.0% vs. 13.3%, P , 0.01) and modestly higher risk-standardized total rates of ventilation (Q4 vs. Q1: 23.9% vs. 22.0%, P = 0.03). Hospitals with the highest RS-NIV% had lower risk-standardized mortality among ventilated patients who received ventilation (Q4 vs. Q1: 8.5% vs. 9.0%, P = 0.01) and marginally lower mortality rates among all patients with COPD (Q4 vs. Q1: 2.2% vs. 2.3%, P = 0.03) compared with hospitals with the lowest RS-NIV%. Higher RS-NIV% was associated with lower hospital costs (Q4 vs. Q1: $11,148 vs. $14,032, P , 0.001), shorter length of stay (Q4 vs. Q1: 5.5 vs. 6.8 d, P , 0.001), and lower NIV failure rates (Q4 vs. Q1: 12.8 vs. 32.5%, P , 0.001).Conclusions: Use of NIV as the initial ventilation strategy for patients with COPD varies considerably across hospitals. Institutions with greater use of NIV have lower rates of invasive mechanical ventilation and better patient outcomes.

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Section: Design Setting and Subjectsmentioning

confidence: 99%

Hospital Patterns of Mechanical Ventilation for Patients with Exacerbations of COPD

Lindenauer

Stefan

Shieh³

et al. 2015

Annals ATS

Self Cite

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show abstract

“…Data are electronically collected from participating sites and audited to ensure validity. The database represents approximately 15% of all annual U.S. hospital admissions and has been extensively used in comparative effectiveness research in COPD (13)(14)(15)(16)(17).…”

Section: Design Setting and Subjectsmentioning

confidence: 99%

Use and Outcomes Associated with Long-acting Bronchodilators among Patients Hospitalized for Chronic Obstructive Pulmonary Disease

Lindenauer¹,

Shieh²,

Pekow³

et al. 2014

Annals ATS

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Rationale: Long-acting b-adrenergic agonists and long-acting anticholinergic agents are recommended for the management of patients with stable chronic obstructive pulmonary disease (COPD); however, their role in the acute setting is uncertain.Objectives: To describe the use and outcomes associated with long-acting bronchodilator therapy (LABD) among patients hospitalized with exacerbations of COPD. Methods:We conducted a retrospective cohort study at 421 U.S. hospitals of patients hospitalized with exacerbations of COPD between January 1, 2010, and June 30, 2011. We used propensity score methods to compare the risk of a composite measure of treatment failure, length of stay, and hospital costs in patients who were treated with an LABD to those who did not receive treatment.Measurements and Main Results: Of the 77,378 patients included in the analysis, 31,725 (41%) were treated with an LABD on Hospital Day 1 or Day 2, including 15,356 (48.4%) who received a long-acting b-agonist, 6,665 (21%) who received a long-acting anticholinergic, and 9,704 (30.6%) who received both. When compared with patients who were not treated with an LABD, treated patients tended to be younger and had a modestly lower comorbidity burden but were more likely to have had prior admission for COPD and to be treated with inhaled corticosteroids. The incidence of treatment failure was similar among those who were or were not treated with LABDs (13.1 vs. 13.6%, P = 0.06). In propensity-matched analyses we found no difference in the risk of treatment failure associated with exposure to LABDs (relative risk [RR], 1.00; 95% confidence interval [CI], 0.96-1.04), minimal differences in hospital cost (RR, 1.02; 95% CI, 1.01-1.03), and no difference in length of stay (RR, 1.01; 95% CI, 1.00-1.02).Conclusions: Despite a lack of evidence, LABDs are commonly prescribed to patients hospitalized for exacerbations of COPD but are not associated with better clinical or economic outcomes. Clinical trials are needed to determine the optimal use of these medications in the acute care setting.

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“…This analysis extends the fi ndings of a previous study published by our group that assessed the role of antibiotics in patients hospitalized with COPD irrespective of systemic steroid use. 10 sputum culture. We recorded the hospital's bed size, teaching status, geographic region, and whether the institution served an urban or rural population.…”

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confidence: 99%

Association Between Antibiotic Treatment and Outcomes in Patients Hospitalized With Acute Exacerbation of COPD Treated With Systemic Steroids

Stefan

Rothberg

Shieh

et al. 2013

Chest

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Background: Antibiotics are widely used in acute exacerbations of COPD (AE-COPD), but their additional benefi t to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of patients treated with steroids who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens.

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Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract: Early antibiotic administration was associated with improved outcomes among patients hospitalized for acute exacerbations of COPD regardless of the risk of treatment failure.

Cited by 177 publications

References 23 publications

Hospital Patterns of Mechanical Ventilation for Patients with Exacerbations of COPD

Hospital Patterns of Mechanical Ventilation for Patients with Exacerbations of COPD

Use and Outcomes Associated with Long-acting Bronchodilators among Patients Hospitalized for Chronic Obstructive Pulmonary Disease

Association Between Antibiotic Treatment and Outcomes in Patients Hospitalized With Acute Exacerbation of COPD Treated With Systemic Steroids

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