Modelo de hospitalización y frecuencia de reingreso en pacientes con exacerbación de EPOC

Abstract

Objective: To evaluate the effectiveness of the Short Stay Unit (USS) in patients who suffer from a chronic obstructive pulmonary disease (COPD) that worsens versus conventional hospitalization (CH) in terms of readmission and mortality.Patient and Method. Non randomized retrospective study of cohorts of patients hospitalized due to exacerbation of EPOC during 2004 in a general hospital. The monitoring was prolonged until December 31st 2006 or the occurrence of an event (death or readmission). The statistical analysis was based on the Kaplan-Meier method, the log-rank test and Cox regression.Results. Of the 543 subjects, 252 were admitted in USS and 291 in CH. Those admitted in USS were more advanced in years (75.4 versus 71.7 years; p < 0,001), and with a tendency to a smaller Charlson index (0.46 versus 0.58; p < 0,07) than the patients in HC. The average stay was 3.2 days in UCE versus 8.9 days in CH (p < 0,001). In the univariant analysis, the patients admitted in USS showed a major incidence of death or readmission (Relative Risk [RR] 1.31; p < 0,001), at the expense of the readmission (RR 1.53; p = 0,013), while there were no differences in mortality (RR 0,82; p=0 ,34). After applying the Cox regression for the hospitalization covariables fit, there was no substantial change in the estimates. The analysis of the survival curves demonstrated that the differences were not due to an increase in precocious readmissions.Conclusions. In the field of the study, the patients with exacerbation of COPD admitted in USS had worse results in readmission terms than the patients admitted in CH.