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Obstructive Lung Diseases |

Epidemiology and Outcomes of Acute Respiratory Failure in Hospitalized Patients in the United States, 2001 - 2009

Mihaela Stefan*, MD; Penelope Pekow, PhD; Meng-Shiou Shieh, PhD; Michael Rothberg, MD; Jay Steingrub, MD; Peter Lindenauer, MD
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Baystate Medical Center, Springfield, MA


Chest. 2012;142(4_MeetingAbstracts):727A. doi:10.1378/chest.1388551
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Abstract

SESSION TYPE: COPD Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The current epidemiology of acute respiratory failure (ARF) in the United States is not well described. We performed a national, population-based study to evaluate trends in incidence, number of hospitalization, etiology and outcomes of ARF-associated hospitalizations in the US.

METHODS: Using the HCUP Nationwide Inpatient Sample we performed a population-based cohort study with time trends of all hospitalizations of patients aged 18 or over diagnosed with ARF between 2001 to 2009. We calculated the weighted frequency of ARF-associated hospitalization and using direct standardization we obtained age- and sex-adjusted population-based mortality rates for ARF per 100,000 population. We used logistic regression to adjust in-hospital mortality rates for patient characteristics. Inflation-adjusted costs were calculated using hospital-specific cost-to-charge ratios.

RESULTS: The number of hospitalizations with a diagnosis of ARF increased steadily from 1,007,549(SD=19,268) in 2001 to 1,917,910(SD=47,558) patients in 2009, an average increase per year of 11.3%. Age and sex adjusted population incidence increased from 502 (SE=10) to 784 (SE=19) cases per 100,000 from 2001 to 2009 (a 56% increase, p<0.0001). While patients older than age 64 had the highest age-specific incidence of ARF each year the greatest relative increase occurred in the younger group (76% increase). Adjusted hospital mortality rate decreased from 27.6% in 2001 to 20.6% in 2009. Over the period 2001-2009 the use of invasive mechanical ventilation declined by 13% (from 48.5% in 2001 to 42% in 2009) while at the same time there was a 166% increase in the use of non-invasive ventilation (from 3.8% in 2001 to 10.1%) in 2009. The common etiologies associated with the diagnosis of ARF in 2009 for non-surgical hospitalizations were: pneumonia (46.1%), heart failure (36.6%), COPD exacerbation(25.4%) and sepsis(21.2%).

CONCLUSIONS: In summary, our study determined the inpatient burden of ARF related hospitalizations and provide a recent nationally representative and generalizable estimate. We have shown that there was a dramatic increase in the number of hospitalizations with ARF, a decrease in mortality and an increase in the use of noninvasive ventilation.

CLINICAL IMPLICATIONS: Our findings highlight the continuing need to improve clinical outcomes in this population and justify prioritizing ARF in health care policy initiatives and national research.

DISCLOSURE: The following authors have nothing to disclose: Mihaela Stefan, Penelope Pekow, Meng-Shiou Shieh, Michael Rothberg, Jay Steingrub, Peter Lindenauer

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Baystate Medical Center, Springfield, MA

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