SESSION TITLE: Acute exacerbations of COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 02:45 PM - 04:15 PM
PURPOSE: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States with at least 500,000 admissions per year for acute exacerbations of COPD (AECOPD). The cost of hospital admissions for AECOPD accounts for up to 70% of total costs for the treatment of COPD patients. We wanted to identify clinical parameters associated with longer lengths of stay (LOS) for AECOPD
METHODS: We reviewed electronic medical record of patients with AECOPD admitted between 1/1/2006 and 12/31/2010. The inclusion criteria were: age 45 year or older, the diagnosis of AECOPD by GOLD guideline criteria, and admission to an intensive care unit (ICU). The exclusion criteria included any history of another respiratory disease. We compared the longest LOS group (quartile four) with the shorter LOS groups (quartiles one to three) using routine clinical data.
RESULTS: There were 325 admissions with AECOPD, and 217 met inclusion criteria. The mean age of the patients was 67.4±10.9 years, 47% were male, the mean FEV1 was 42.4±17.4 % of predicted, and the mean LOS was 9.0±6.0 days. Univariate analysis demonstrated that nursing home status, low albumins, the presence of a pleural effusions, intubation, and high APACHE II scores were associated with increased LOS (p<0.05 for each factor). Multivariate logistic regression demonstrated that the need for intubation (p<0.001) predicted increased LOS.
CONCLUSIONS: : Earlier studies have been reported that the average LOS for patients with AECOPD was 6 to 8 days and found that increased age, lower FEV1s, and mechanical ventilation increased LOS. The length of stay was longer in our study because these patients required ICU admission. Our study demonstrates that intubation for mechanical ventilation increased the LOS.
CLINICAL IMPLICATIONS: More intensive interventions in these patients with risk of higher LOS might decrease the LOS and adverse outcomes in ICU.
DISCLOSURE: The following authors have nothing to disclose: Chok Limsuwat, Charoen Mankongpaisarnrung, Nat Dumrongmongcolgul, Keneth Nugent
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