Length of hospital stay, delayed pneumonia diagnosis and post-discharge mortality. The Pneumonia in Italian Acute Care for Elderly units (PIACE)-SIGOT study

Background

High-income countries are currently decreasing length of hospital stay (LOS), with the aim of improving resource utilization. Little is known about the contribution of LOS to short-term post-discharge mortality in older patients with pneumonia.

Aim

to identify factors independently associated with LOS and to determine whether LOS predicts 3-month post-discharge death in older patients hospitalized for pneumonia.

Method

Prospective observation of 318 consecutive patients in the Pneumonia In Italian Acute Care for Elderly units (PIACE) study. Geriatric risk factors and the time between the onset of symptoms and pneumonia diagnosis (time to diagnosis, TTD) were included in the analysis.

Results

Long TTD (odds ratio [OR] 1.104, 95 % confidence interval [CI] 1.008–1.210) and hypoalbuminemia (0.606, 0.392–0.937) were significant correlates of longer LOS (≥ 11 days) in the logistic regression analysis. TTD was shorter in more severe patients, and healthcare associated pneumonia was inversely related to TTD > 1 day (0.471, 0.258–0.859). At Cox regression analysis, longer LOS independently predicted 3-month post-discharge death (hazard ratio [HR] 2.309, 95 % CI 1.229–4.341), together with severity of pneumonia (or of acute illness), comorbidity, disability at discharge and not being discharged to home. LOS was not anymore significant after adjustment for hypoalbuminemia (0.210, 0.118–0.375) and longer TTD (1.103, 1.020–1.193), that independently predicted post-discharge death together with comorbidity and disability at discharge.

Conclusion

Longer LOS characterizes patients with severe hospital presentation and consequently predicts post-discharge death, but delayed pneumonia diagnosis, a modifiable process of care measure, may contribute to both longer LOS and increased post-discharge death.