2018 Issues   /   Pulmonary Disease

Longer LOS Doesn’t Reduce COPD Readmissions

By U.S. Medicine

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.

Related Articles

Supplemental Oxygen Needs Rarely Addressed in COPD Inpatients

CHICAGO — Patients hospitalized with chronic obstructive pulmonary disease (COPD) who require supplemental oxygen (O2) are at increased risk of hospital readmissions, but little information exists on the quality of evaluation and documentation regarding the need for supplemental O2 in that population.

Lobectomy Still Has Significant Survival Benefit in Early NSCLC

While increased use of stereotactic body radiation might have played a key role in doubling survival rates for early-stage non-small cell lung cancer (NSCLC) among veterans between 2001 and 2010 compared to conventional radiation, a new study confirms that isn’t always the best way to assure longer survival.


U.S. Medicine Recommends


More From copd

COPD

Supplemental Oxygen Needs Rarely Addressed in COPD Inpatients

CHICAGO — Patients hospitalized with chronic obstructive pulmonary disease (COPD) who require supplemental oxygen (O2) are at increased risk of hospital readmissions, but little information exists on the quality of evaluation and documentation regarding the need for supplemental O2 in that population.

COPD

Hospitalized COPD Patients More Likely to Also Have PH

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access... View Article

Asthma

Underweight and Smoking Makes for a Lethal Combination in COPD

When counseling a patient with chronic obstructive pulmonary disease (COPD), many clinicians start with two words of advice: “Stop smoking.”

Asthma

How Ignoring COPD Guidelines Helped Veterans

Failing to follow international guidelines on treatment of chronic obstructive pulmonary disease (COPD) isn’t always bad medicine, a new study reported.

COPD

COPD Associated With Frailty in HIV-Infected Veterans

With chronic obstructive pulmonary disease (COPD) prevalence increasing among aging HIV-infected patients, a recent study sought to determine how that relates to frailty in veterans treated at the VA.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up