Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Abstract

Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

The Clinical Implications of Carbon Dioxide Increased Level in Arterial Blood Related to Severe Exacerbations of Chronic Obstructive Pulmonary Disease

“…It was noticed a high predominance of male smokers among COPD inpatients (n=112/162; 69.1%) versus females (n=12/33; 36.3%), for odd ratio (OR) of 2.05 (0.84-4.96) and risk ratio (RR) of 1.32 (0.88-1.98), without significant differences of distribution by gender (chi 2 =2.6, p= 0.106). Professional exposure to particles and dust was incriminated in 75.9% of cases (n=123/162), a high incidence consistent with other studies [16]. The clinical implications of respiratory failure among COPD inpatients varied from aggravated exertional dyspnea, increase in volume and purulence of sputum, to resting dyspnea, orthopnea, cyanosis, weakness, paradoxical breathing as a sign of muscle fatigue described in 170 patients (87.17%).…”

Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial

“…Notably, duration of hospitalisation in the COPD control group is consistent with that quoted in a large, contemporaneous UK study. 25 The reduction in length of stay for patients with exacerbation of airways disease was in the order of 1 day, which would equate to around 200 000 bed days saved per year across the NHS with an associated cost saving of around £80 million per year (a formal health economic analysis of our trial will be published separately). 26 Routine POCT for respiratory viruses was also associated with an increased rate of detection of influenza cases and an improvement in antiviral use.…”

Tendência das internações e da mortalidade de idosos por condições sensíveis à atenção primária

“…A study conducted in 13 European countries with 16,018 patients diagnosed with COPD found that the main factors associated with prolonged length of stay were related to the severity or exacerbation of the disease. With effective and timely health care, these individuals should not reach the hospital unit so debilitated 24 .…”