Longer LOS Doesn’t Reduce COPD Readmissions

BEDFORD, MA—Recent financial penalties for high risk-adjusted chronic obstructive pulmonary disease (COPD) readmissions have pushed hospitals to search for ways to reduce readmissions for chronic obstructive pulmonary disease, a new study notes.

The report in the American Journal of Managed Care pointed out that some experts have advocated for increasing the length of stay (LOS) as a method to decrease readmissions. A study team led by researchers at the Bedford, MA, VAMC noted, however, that the association between LOS and readmission is unclear—something they sought to remedy by examining the association between LOS and readmission among patients admitted for COPD.1

To do that, the researchers conducted an observational study of 33,558 veterans admitted to 130 VA hospitals for COPD from Oct. 1, 2008, to Sept. 30, 2011. The analysis separately examined the associations of patient and hospital LOS with 30-day all-cause readmission.

Results indicated that, at the patient level, compared with short LOS (less than three days), a longer LOS was associated with increased risk for readmission. The adjusted odds ratio was 1.39 (95% confidence interval [CI], 1.18-1.63) for medium LOS (3-4 days) and 2.03 (95% CI, 1.72-2.40) for long LOS (>4 days). No association between LOS and readmission was determined on the hospital level, study authors wrote.

“On a patient level, a longer LOS for COPD hospitalizations was associated with higher risk for readmission, which is likely confounded by the severity of the illness,” the researchers explained, adding, “These findings imply that, independent of other transitional care practices, altering the hospital LOS may not influence the risk of readmission.”

The study team said the takeaways from their review were that:

  • Patient-level LOS was associated with increased risk of readmission, which was likely due to residual confounding of severity of illness. 
  • Hospital-level LOS was not associated with readmission, and there was no association between risk-adjusted readmission and LOS. 
  • These findings imply that a strategy of simply keeping patients in the hospital longer is not likely to be an effective approach for reducing the risk of readmissions.
  1. Rinne ST, Graves MC, Bastian LA, Lindenauer PK, Wong ES, Hebert PL, Liu CF. Association between length of stay and readmission for COPD. Am J Manag Care. 2017 Aug 1;23(8):e253-e258. PubMed PMID: 29087152.

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