Trends in In-Hospital Outcomes Among Adults Hospitalized With Exacerbation of Chronic Obstructive Pulmonary Disease.
BACKGROUND
Although substantial advances have been made in the treatment of chronic obstructive pulmonary disease (COPD), little is known regarding the impact of these advancements on inpatient outcomes over time. We sought to examine temporal trends in in-hospital outcomes among adults hospitalized with COPD exacerbation.


METHODS
The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was utilized to identify a cohort of adults hospitalized with COPD exacerbation, identified through International Classification of Diseases-9 codes. Baseline demographics, medical history, and clinical outcomes were assessed in 3,060,565 hospitalizations in patients with COPD exacerbation from 2006-2009.


RESULTS
In-hospital all-cause mortality significantly decreased over the 4-year study period (5.1%, 4.7%, 4.5%, and 4.2% from 2006-2009; p < 0.001). The decline in mechanical ventilation (5.8% 5.7%, 5.3%, and 5.4% from 2006-2009; p < 0.001) was accompanied by a nearly 50% rise in noninvasive positive pressure ventilation utilization (NIPPV) (2.3%, 2.9%, 3.3%, and 3.5% from 2006-2009; p < 0.001). Average hospital length of stay (LOS) decreased over the study period (6.3, 6.1, 5.8, and 5.7 days from 2006-2009; p < 0.001). These relationships remained significant in fully-adjusted multivariate analyses (referent year 2006: p < 0.001 for years 2007-2009 for mortality, mechanical ventilation, and hospital LOS; p < 0.001 for years 2008-2009). Multivariate analysis of predictors of mortality remained similar for Years 2006-2009 with mechanical ventilation, age greater than 75 years, and NIPPV use serving as the strongest predictors of mortality.


CONCLUSIONS
During 2006-2009, a significant decline in mortality was accompanied by less frequent mechanical ventilation, more frequent NIPPV use, and shorter LOS in adults hospitalized with COPD exacerbation.
a Department of Medicine, Division of Pulmonary/Critical Care Medicine , Stony Brook University Medical Center , Stony Brook , New York , USA.
Fabio V
FV
Lima
b Department of Preventive Medicine , Stony Brook University , Stony Brook , New York , USA.
Tzyy Yun Michael
TY
Yen
a Department of Medicine, Division of Pulmonary/Critical Care Medicine , Stony Brook University Medical Center , Stony Brook , New York , USA.
Jignesh K
JK
Patel
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial; D014481:United States / Q000453:epidemiology