SESSION TITLE: Outcomes/Quality Control
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM
PURPOSE: Obstructive sleep apnea (OSA) is an important under diagnosed comorbidity in hospitalized patients, while pneumonia remains a common cause of acute respiratory failure. This retrospective study examined outcomes associated with OSA on patients with pneumonia requiring invasive mechanical ventilation (IMV).
METHODS: The Nationwide Inpatient Sample (NIS) was investigated for discharges with a primary diagnosis of pneumonia requiring IMV between the years of 2009 and 2011. Persons with a secondary diagnosis of OSA were compared to a cohort of patients without OSA. Primary outcomes included in-hospital mortality, non-routine discharge, need for tracheostomy, and length of stay. Stepwise logistic regression models were used to describe the risk of OSA on in-hospital mortality, discharge status, and tracheostomy rates. We adjusted for patient characteristics including age, sex, obesity, comorbidities (i.e. atrial fibrillation, lung cancer), and illness severity (i.e. sepsis, shock).
RESULTS: A total of 21,652 discharges in the NIS met inclusion criteria, representing 107,453 discharges nationally. Among all discharges, the mean age was 65 years (SD=37.12 years), 5,636 (51.8%) were male, 11,859 (11.0%) were obese and 9,027 (8.4%) had OSA. Overall mortality was 30.4%, and overall rate of non-routine discharge was 83.8%. OSA patients had a significantly lower rate of in-hospital mortality (19.3% vs. 31.4%,p<0.0001) and non-routine discharge (76.9% vs. 84.4%,p<0.0001) when compared to those without OSA, but had significantly higher rates of tracheostomy (9.2% vs. 8.3%,p=0.008). There were no significant differences in length of stay (mean ± standard error: OSA 14.1±0.1 days, non-OSA 14.4±0.3 days,p=0.17). In adjusted logistic models, OSA was associated with a 26% decreased risk of in-hospital mortality (OR:0.74, 95% CI: 0.70 - 0.79,p<0.0001) and a 27% decreased risk of non-routine discharge (OR:0.73, 95% CI:0.69 - 0.77,p<0.0001), but no significant impact on tracheostomy risk.
CONCLUSIONS: Among mechanically ventilated patients diagnosed with pneumonia, persons with OSA required more tracheostomies but had overall lower rates of in-hospital mortality and non-routine discharge compared to persons without OSA. After adjustment of patient characteristics, OSA was a significant predictor for decreased in-hospital mortality and non-routine discharge.
CLINICAL IMPLICATIONS: Data suggest that OSA may be protective in hospitalized patients with acute respiratory failure due to pneumonia, yet further research is warranted.
DISCLOSURE: The following authors have nothing to disclose: Charlisa Gibson, Pius Ochieng, Raymond Jean, Raymonde Jean
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