Prolonged Hospitalization Following Acute Respiratory Failure

Area of Science:

• Critical Care Medicine
• Health Services Research
• Pulmonary Medicine

Background:

• Acute respiratory failure (ARF) is a critical condition requiring intensive care.
• Prolonged hospitalization (pLOS) in ARF patients presents significant clinical and economic challenges.
• Understanding determinants of pLOS is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To investigate the incidence, mortality, cost, and clinical determinants of prolonged hospitalization (≥ 60 days) among adult patients with ARF requiring mechanical ventilation.
• To analyze trends in these outcomes from 2004 to 2014.
• To identify patient- and hospital-level factors associated with pLOS.

Main Methods:

• Utilized the National Inpatient Sample (NIS) database from 2004 to 2014.
• Identified adult patients (≥ 18 years) with ARF (ICD-9 codes 518.81 or 518.82) requiring mechanical ventilation (ICD-9 codes 96.7, 96.04, or 96.05).
• Employed logistic regression, linear regression, and generalized linear modeling with Poisson distribution to assess outcomes and trends.

Main Results:

• Identified 5,539,567 patients with ARF; 77,665 (1.4%) experienced pLOS (≥ 60 days).
• Incidence of pLOS decreased by 48% and in-hospital mortality by 18% over the study period.
• pLOS was associated with urban teaching hospitals, northeastern US locations, and Medicaid insurance; per-patient costs increased, but the proportion of total ARF costs for pLOS patients remained stable.

Conclusions:

• Despite decreasing incidence and mortality, prolonged hospitalizations for ARF remain a significant concern with rising per-patient costs.
• Significant variations in pLOS exist based on geographic region, hospital type (teaching status), and patient insurance.
• Further research into targeted interventions for high-risk populations and healthcare settings is warranted to mitigate the impact of prolonged ARF hospitalizations.