title: Length of stay of COPD hospital admissions between 2006 and 2010: a retrospective longitudinal study.
abstract: BACKGROUND
  Hospitalizations for COPD are associated with poor patient prognosis. Length of stay (LOS) of COPD admissions in a large urban area and patient and hospital factors associated with it are described.
  
  
  METHODS
  Retrospective longitudinal study. All COPD patients registered with London general practitioners and admitted as an emergency with COPD (2006-2010), not having been admitted with COPD in the preceding 12 months were included. Association of patient and hospital characteristics with mean LOS of COPD admissions was assessed. Association between hospital and LOS was determined by negative binomial regression.
  
  
  RESULTS
  The total number of admissions was 38,504, from 22,462 patients. The mean LOS for first admissions fell by 0.8 days (95% confidence interval [CI]: 0.7-1.5) from 8.2 to 7.0 days between 2006 and 2010. Seventy-nine percent of first admissions were ≤10 days, with a mean LOS of 3.7 days (2009-2010). The mean LOS of successive COPD admissions of the same patients was the same or less throughout the study period. The interval between successive admissions fell from a mean of 357 days between the first and second admission to a mean of 19 days after eight admissions. Age accounted for 2.3% of the variance in LOS. Socioeconomic deprivation did not predict LOS. Fewer discharges happened at the weekend (1,893/day) than on weekdays (5,218/day). The mean LOS varied between hospitals, from 4.9 days (95% CI: 3.8-5.9) to 9.5 days (95% CI: 8.6-10.3) when adjusting for clustering, age, sex, and socioeconomic deprivation.
  
  
  CONCLUSIONS
  The fall in LOS of the first COPD admission between 2006 and 2010 reflects international trends. The stability of LOS in successive admissions suggests that increasing severity of disease does not affect recovery time from an exacerbation. Variations between hospitals of nearly 5 days in LOS for COPD admissions suggests that significant improvements in patient outcomes and in savings in health care utilization could be made in hospitals with longer LOS.
authors.affiliation: King's College London, King's Health Partners, Division of Health and Social Care Research, London, UK.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Harries
authors.affiliation: University of Bristol, Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, Canynge Hall, Bristol, UK.
authors.forename: Hannah V
authors.initials: HV
authors.lastname: Thornton
authors.affiliation: King's College London, King's Health Partners, Division of Health and Social Care Research, London, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
authors.affiliation: King's College London, King's Health Partners, Division of Health and Social Care Research, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.affiliation: King's College London, King's Health Partners, Division of Health and Social Care Research, London, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gilkes
authors.affiliation: King's College London, King's Health Partners, Division of Health and Social Care Research, London, UK.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: White
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000639:trends; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D058006:General Practice / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008131:London; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014504:Urban Health / Q000639:trends
keywords: LOS; general practice; hospitalization
references.citation: Thorax. 2002 Oct;57(10):847-52
references.pmid: 12324669
references.citation: BMC Health Serv Res. 2014;14:270
references.pmid: 24947670
references.citation: Intern Med J. 2013 Jun;43(6):721-4
references.pmid: 23745995
references.citation: Int J Chron Obstruct Pulmon Dis. 2012;7:789-96
references.pmid: 23226015
references.citation: Proc Am Thorac Soc. 2006 Sep;3(7):619-23
references.pmid: 16963544
references.citation: BMJ Open. 2012 Nov 06;2(6):null
references.pmid: 23135542
references.citation: Thorax. 2005 Nov;60(11):925-31
references.pmid: 16055622
references.citation: QJM. 2011 Oct;104(10):859-66
references.pmid: 21622541
references.citation: Respir Med. 2003 Mar;97 Suppl C:S71-9
references.pmid: 12647945
references.citation: Int J Chron Obstruct Pulmon Dis. 2014;9:99-105
references.pmid: 24477272
references.citation: Qual Saf Health Care. 2010 Jun;19(3):213-7
references.pmid: 20110288
references.citation: Thorax. 2012 Nov;67(11):957-63
references.pmid: 22684094
references.citation: Lancet. 2003 Feb 8;361(9356):449-56
references.pmid: 12583942
references.citation: J Gen Intern Med. 2015 Jun;30(6):824-31
references.pmid: 25472508
references.citation: J Gen Intern Med. 2009 Sep;24(9):1043-8
references.pmid: 19597892
references.citation: J Health Serv Res Policy. 2011 Jul;16(3):133-40
references.pmid: 21719477
references.citation: Thorax. 2006 Apr;61(4):284-9
references.pmid: 16449265
references.citation: Thorax. 2012 Apr;67(4):371-3
references.pmid: 22250099
references.citation: COPD. 2011 Oct;8(5):354-61
references.pmid: 21864116
references.citation: Can Respir J. 2008 Oct;15(7):361-4
references.pmid: 18949105
references.citation: PLoS Med. 2006 Nov;3(11):e442
references.pmid: 17132052
references.citation: BMJ Open. 2012 Sep 01;2(5):null
references.pmid: 22942230
references.citation: Am J Med. 2006 Oct;119(10 Suppl 1):38-45
references.pmid: 16996898
references.citation: Respir Med. 2007 Apr;101(4):754-61
references.pmid: 17045788
references.citation: N Engl J Med. 2008 Oct 9;359(15):1543-54
references.pmid: 18836213
references.citation: Int J Qual Health Care. 2000 Feb;12(1):41-6
references.pmid: 10733082
references.citation: Respir Med. 2013 May;107(5):717-23
references.pmid: 23421969
references.citation: Thorax. 2006 Oct;61(10):843-8
references.pmid: 16928716
references.citation: Eur Respir J. 2012 Jan;39(1):46-50
references.pmid: 21659418
references.citation: N Engl J Med. 2007 Feb 22;356(8):775-89
references.pmid: 17314337
references.citation: Am J Respir Crit Care Med. 2008 Jan 1;177(1):19-26
references.pmid: 17916806
references.citation: Thorax. 2006 Oct;61(10):837-42
references.pmid: 16449268
references.citation: Eur J Heart Fail. 2010 Jan;12(1):17-24
references.pmid: 19951962