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

Filippo Luca Fimognari; Paolo Fabbietti; Francesco Baffa Bellucci; Andrea Corsonello; Roberto Ricchio; Massimo Rizzo; Olga Cuccurullo; Alberto Ferrari; Lorenzo Palleschi; PIACE-SIGOT Investigators

doi:10.1016/j.ejim.2024.12.014

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

Eur J Intern Med. 2024 Dec 18:S0953-6205(24)00509-0. doi: 10.1016/j.ejim.2024.12.014. Online ahead of print.

Authors

Filippo Luca Fimognari¹, Paolo Fabbietti², Francesco Baffa Bellucci¹, Andrea Corsonello³, Roberto Ricchio¹, Massimo Rizzo¹, Olga Cuccurullo¹, Alberto Ferrari⁴, Lorenzo Palleschi⁵; PIACE-SIGOT Investigators

Affiliations

¹ Unit of Geriatrics, Medical Department, Azienda Ospedaliera Annunziata-Mariano Santo-S. Barbara, Cosenza, Italy.
² Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Aging (INRCA), Ancona, Italy. Electronic address: p.fabbietti@inrca.it.
³ Unit of Geriatrics, INRCA-Research Hospital of Cosenza and University of Calabria (UNICAL), Cosenza-Rende, Italy.
⁴ Unit of Geriatrics, S. Maria Nuova Hospital, Reggio Emilia, Italy.
⁵ Unit of Geriatrics, Department of Internal Medicine, Azienda Ospedaliera S. Giovanni-Addolorata, Rome, Italy.

PMID: 39701911
DOI: 10.1016/j.ejim.2024.12.014

Abstract

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.

Keywords: Community-acquired pneumonia; Geriatrics acute care hospital units; Length of hospital stay; Older patients; Pneumonia; Time to pneumonia diagnosis.