Factors influencing the length of hospital stay in patients with acute exacerbations of chronic obstructive pulmonary disease admitted to intensive care units.
BACKGROUND
The cost of hospital admissions for acute exacerbations of COPD (AECOPD) accounts for 70% of total costs for the treatment of COPD patients. We wanted to identify clinical parameters associated with a longer length of stay (LOS) in these patients.


METHODS
We reviewed electronic medical records of patients with AECOPD admitted between January 1, 2006, and December 31, 2010. The inclusion criteria were age 45 years or older, the diagnosis of AECOPD by GOLD (Global Initiative for Chronic Obstructive Lung Disease) guideline criteria, and admission to an intensive care unit. We compared the quartile with the longest LOS group with the other 3 quartiles using routine clinical data.


RESULTS
217 patients met inclusion criteria. The mean age was 67.4 ± 10.9 years, 47% were male, the mean FEV1s (forced expiratory volume in 1 second) 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 pleural effusions, intubation, and high APACHE II scores were associated with increased LOS (P < .05 for each factor). Multivariate logistic regression demonstrated that the need for intubation (P < .001) predicted an increased LOS.


CONCLUSIONS
Our study demonstrates that intubation for mechanical ventilation increased the LOS in patients with AECOPD. More intensive interventions in these patients might decrease the LOS and improve outcomes.
Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, Texas.
Chok
C
Limsuwat
Charoen
C
Mankongpaisarnrung
Nat
N
Dumrongmongcolgul
Kenneth
K
Nugent
D018806:APACHE; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010996:Pleural Effusion / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin