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.

Conclusion: 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.

Keywords: LOS; general practice; hospitalization.

Figure 1

Mean LOS (±95% CI) of all COPD admissions (2006–2010) among patients aged ≥45 years and mean LOS (±95% CI) of patients aged ≥45 years admitted for the first time in at least 12 months (2006–2010). Note: *Period for each year ran from April 1 to March 31. Abbreviations: CI, confidence interval; LOS, length of stay.

Figure 2

Mean LOS per COPD admission (±95% CI) among study patients not admitted for COPD during the preceding 12 months, plotted against mean time in days to that admission from their first admission in 2006–2007. Abbreviations: CI, confidence interval; LOS, length of stay.

Figure 3

LOS (box and whisker plot of median, interquartile ranges, and outliers) of all COPD admissions (2006–2010) of patients registered with London general practices not having had a COPD admission in the 12 months prior to their first admission after April 1, 2006 to English hospitals reporting at least 100 such admissions. Abbreviation: LOS, length of stay.

Figure 4

Mean LOS (±95% CI) of all COPD admissions (36,893) to included English hospitals between 2006–2010, and adjusted for clustering, age, sex, and geographical deprivation score of patients. Abbreviations: CI, confidence interval; LOS, length of stay.

Figure 5

Mean LOS (±95% CI) of COPD admissions ≤10 days (29,255) to included English hospitals between 2006–2010, shown in ascending order and adjusted for clustering, age, sex, and geographical deprivation score of patients. Abbreviations: CI, confidence interval; LOS, length of stay.

Figure 6

Mean LOS (±95% CI) of COPD admissions ≤10 days (27,813) to included English hospitals between 2006–2010, and adjusted for clustering, age, sex, and geographical deprivation score of patients. Note: Deaths excluded. Abbreviations: CI, confidence interval; LOS, length of stay.