To investigate the use of palliative care (PC) in patients with end-stage chronic obstructive pulmonary disease (COPD) on home oxygen hospitalized for an exacerbation
Retrospective nationwide cohort analysis utilising the Nationwide Inpatient Sample (NIS). All patients >18 years of age with a diagnosis of COPD on home oxygen admitted for an exacerbation were included.
55,208,382 hospitalizations from the 2006-2012 NIS samples were examined. There were 181,689 patients with COPD on home oxygen admitted for an exacerbation, 3,145 (1.7%) patients also had a palliative care contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%, p<0.01). Patients receiving palliative care consultations compared to those who did not were: older (75.0 years SD 10.9 vs 70.6 years SD 9.7, p<0.01), had longer hospitalizations (4.9 days IQR 2.6-8.2 vs 3.5 days IQR 2.1-5.6) and more likely to die in hospital (32.1% vs 1.5%, p<0.01). Race was significantly associated with referral to palliative care, with White patients referred more often than minorities (p<0.01). Factors associated with PC referral were: age (OR 1.03, 95% CI 1.02-1.04, p<0.01), metastatic cancer (OR 2.40, 95% CI 2.02-2.87, p<0.01), non-metastatic cancer (OR 2.75, 95% CI 2.43-3.11, p<0.01), invasive mechanical ventilation (OR 4.89, 95% CI 4.31-5.55, p<0.01), non-invasive mechanical ventilation (OR 2.84, 95% CI 2.58-3.12, p<0.01), and DNR status (OR 7.95, 95% CI 7.29-8.67, p<0.01).
The use of PC increased dramatically during the study period, however PC contact occurs only in a minority of end-stage COPD patients admitted with an exacerbation.