Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record

Abstract

Purpose: This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao.

Patients and methods: Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression.

Results: A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535-1.072), being female (B=-1.147, 95% CI:-0.138-0.056), being current (B=-0.086, 95% CI:-0.124-0.018) or previous smoker (B=0.072, 95% CI:0.004-0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034-0.147; B=0.125, 95% CI:0.031-0.144; B=0.116, 95% CI:0.028-0.146, B=0.090, 95% CI:0.021-0.166) and having low hemoglobin level (B=-0.118, 95% CI:-0.629- -0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022-0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212-0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003-0.166, B=0.255, 95% CI:0.083-0.237) were significantly associated with longer LOS (P<0.05).

Conclusion: NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.

Keywords: Macao; acute exacerbation; blood test results; chronic obstructive pulmonary disease; clinical therapy; inhaled medications; length of hospital stay.