Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
BACKGROUND
Early identification of patients with a prolonged stay due to acute exacerbation of chronic obstructive pulmonary disease (COPD) may reduce risk of adverse event and treatment costs. This study aimed to identify predictors of prolonged stay after acute exacerbation of COPD based on variables on admission; the study also looked to establish a prediction model for length of stay (LOS).


METHODS
We extracted demographic and clinical data from the medical records of 599 patients discharged after an acute exacerbation of COPD between March 2006 and December 2008 at Oslo University Hospital, Aker. We used logistic regression analyses to assess predictors of a length of stay above the 75th percentile and assessed the area under the receiving operating characteristic curve to evaluate the model's performance.


RESULTS
We included 590 patients (54% women) aged 73.2±10.8 years (mean ± standard deviation) in the analyses. Median LOS was 6.0 days (interquartile range [IQR] 3.5-11.0). In multivariate analysis, admission between Thursday and Saturday (odds ratio [OR] 2.24 [95% CI 1.60-3.51], P<0.001), heart failure (OR 2.26, 95% CI 1.34-3.80), diabetes (OR 1.90, 95% CI 1.07-3.37), stroke (OR 1.83, 95% CI 1.04-3.21), high arterial PCO2 (OR 1.26 [95% CI 1.13-1.41], P<0.001), and low serum albumin level (OR 0.92 [95% CI 0.87-0.97], P=0.001) were associated with a LOS >11 days. The statistical model had an area under the receiver operating characteristic curve of 0.73.


CONCLUSIONS
Admission between Thursday and Saturday, heart failure, diabetes, stroke, high arterial PCO2, and low serum albumin level were associated with a prolonged LOS. These findings may help physicians to identify patients that will need a prolonged LOS in the early stages of admission. However, the predictive model exhibited suboptimal performance and hence is not ready for clinical use.
Health Services Research Unit, Lørenskog, Norway ; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway ; Faculty of Medicine, University of Oslo, Lørenskog, Norway.
Ying
Y
Wang
Health Services Research Unit, Lørenskog, Norway ; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway ; Faculty of Medicine, University of Oslo, Lørenskog, Norway.
Knut
K
Stavem
Health Services Research Unit, Lørenskog, Norway.
Fredrik A
FA
Dahl
Department of Pulmonary Medicine, Oslo University Hospital, Aker, Norway.
Sjur
S
Humerfelt
Health Services Research Unit, Lørenskog, Norway ; Clinic for Allergy and Airway Diseases, Oslo, Norway.
Torbjørn
T
Haugen
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors
COPD; exacerbation; length of stay; predicting model; predictors