Allergy and Airway |

Temporal Trends in Outcomes for Adults Hospitalized With Chronic Obstructive Pulmonary Disease Exacerbations FREE TO VIEW

Fabio Lima, MPH; Tzyy Yun Yen, MPH, MPA; Jignesh Patel, MD
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Stony Brook Medicine, Stony Brook, NY

Chest. 2014;146(4_MeetingAbstracts):64A. doi:10.1378/chest.1983717
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SESSION TITLE: COPD Exacerbation Risk

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM

PURPOSE: Although substantial advances have been made in the treatment of chronic obstructive pulmonary disease (COPD), little information is available on whether any change in inpatient outcomes have been exhibited over time in these patients. The aim of this study was to examine temporal trends in outcomes among patients hospitalized with exacerbations of COPD.

METHODS: The Healthcare Cost and Utilization Project’s National Inpatient Sample was utilized to identify a cohort of 5,481,306 adults hospitalized with COPD in the U.S. from 2006-2010. Demographic data and clinical history were recorded in these patients. Outcomes of interest included all-cause inpatient mortality, mechanical ventilation, non-invasive positive pressure ventilation, hospital length of stay, and total hospital charges.

RESULTS: Over the 5-year study period, the average age of hospitalized COPD patients decreased with the greatest percentage of patients less than age 65 years being hospitalized in 2010. Hospitalization rates for women also increased. Diabetes mellitus became increasingly prevalent over the 5-year period while renal failure and myocardial infarction became decreasingly prevalent. With respect to outcomes, in-hospital all-cause mortality significantly decreased (p < 0.001). Mechanical ventilation use decreased over the study period, accompanied by a nearly 2-fold increase in non-invasive positive pressure ventilation use. While average hospital length of stay decreased, total hospital charges increased over the study period.

CONCLUSIONS: In patients hospitalized with COPD exacerbation, a significant decrease was noted in rates of in-hospital mortality between the period of 2006-2010, accompanied by less frequent use of mechanical ventilation, more frequent use of non-invasive positive pressure ventilation, shorter hospital length of stay, and higher total hospital charges.

CLINICAL IMPLICATIONS: Increased utilization of non-invasive positive pressure ventilation appears to be linked to earlier hospital discharge and reduced rates of mechanical ventilation. Trends suggest a shifting paradigm in the patient population presenting with COPD exacerbation that recently includes younger, female, diabetic patients.

DISCLOSURE: The following authors have nothing to disclose: Fabio Lima, Tzyy Yun Yen, Jignesh Patel

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