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. 2021 Mar 24;21(1):104.
doi: 10.1186/s12890-021-01454-1.

Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals

Berna Demiralp  1 , Lane Koenig  2 , Jing Xu  1 , Samuel Soltoff  1 , John Votto  3
Affiliations

Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals

Berna Demiralp et al. BMC Pulm Med. .

Abstract

Background: Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH.

Methods: Using 2014-2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics.

Results: The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality.

Conclusions: Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients' discharge to LTACH may negatively influence the patients' chances of being weaned from the ventilator.

Keywords: Length of stay; Mortality; Ventilator weaning.

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Conflict of interest statement

BD and LK are employed by KNG Health Consulting, LLC, which has conducted consulting for National Association of Long-Term Hospitals (NALTH). JX, and SS were employed by KNG Health Consulting, LLC at the time the study was conducted. LK serves Director of Policy and Research for NALTH. JV served as the Chief Medical Officer for NALTH.

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