FACTORS THAT MAY INCREASE THE ODDS OF REQUIRING HOME OXYGEN UPON DISCHARGE IN PATIENTS ADMITTED FOR COPD EXACERBATION

Abstract

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: COPD exacerbations are frequently associated with worsening hypoxemia and long-term oxygen therapy (LTOT) needs. Factors that might serve as predictors for worsening hypoxemia leading to use of LTOT have not been studied directly. Our study’s primary objective was the determination of risk factors that may contribute to the increased odds of patients requiring LTOT upon discharge when admitted with COPD exacerbations with no prior oxygen use. METHODS: We performed a retrospective chart review of all adult patients (18 years and above) admitted to a community hospital between January 2014 to January 2018 for COPD exacerbation. A total of 1233 charts were reviewed of which patients with prior home oxygen use and those who died or left against medical advice were excluded prior to analysis. A matched case-control analysis was applied to identify cases and controls. After matching, 90 cases and 550 controls were analyzed. Multiple potential risk factors, including tobacco and marijuana smoking, body mass index, underlying pneumonia and influenza, lowest oxygen saturation, prior exacerbations, anemia, left heart failure, interstitial lung disease, asthma, sleep apnea and newly diagnosed pulmonary embolism (PE) were studied. Age, gender and length of stay were matched between cases (with home oxygen on discharge) and controls (without home oxygen on discharge). SAS 9.3 was used for the statistical analysis. Descriptive analysis was used to describe mean, median, standard deviation and percentage. Chi-square test was applied for categorical variables analysis and Wilcoxon test was applied for continuous variables analysis. A logistic regression model was used to detect multivariable significance. RESULTS: Of all the potential risk factors reviewed, asthma (p<0.04) and sleep apnea (p <0.0001) were statistically significant categorical variables and length of stay (p<0.05) and lowest oxygen saturation (p <0.001) were statistically significant contiguous variables. Next, a logistic regression model was used for analysis revealing age and sleep apnea to be significant variables. Odds Ratio for sleep apnea was 4.073 (p<0.0001) and age was 1.023 (p=0.04). CONCLUSIONS: Patients with sleep apnea are 4 times more likely to be prescribed home oxygen at the time of discharge than those without sleep apnea. In addition, with every year increase in age, patients are 2% more likely to require home oxygen upon discharge when admitted for COPD exacerbations. CLINICAL IMPLICATIONS: Worsening Hypoxemia post a COPD exacerbation is commonly encountered in clinical practice and often leads to delay in discharge of the patients, with the hope of improvement during hospitalizations. Our study demonstrates that advancing age and underlying sleep apnea might increase the possibility of patients getting discharged on LTOT when admitted for COPD exacerbations with no prior home oxygen use. DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 Added 06/10/2019 by Brad Bemiss, source=Web Response, value=Travel and payment for lecture No relevant relationships by Diana Estefania Espinoza Barrera, source=Web Response No relevant relationships by Sindhu Joseph, source=Web Response No relevant relationships by Malvika Kaul, source=Web Response No relevant relationships by Manuel Manrique, source=Web Response No relevant relationships by Swathi Rao, source=Web Response