KNG Health Consulting, LLC, 15245 Shady Grove Road, # 365, Rockville, MD, 20850, USA.
Hospital for Special Care, 2150 Corbin Ave, New Britain, CT, 06053, USA.
BMC Pulm Med. 2021 Mar 24;21(1):104. doi: 10.1186/s12890-021-01454-1.
Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH.
Using 2014-2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics.
The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality.
Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients' discharge to LTACH may negatively influence the patients' chances of being weaned from the ventilator.
长期急性护理医院（LTACH）收治机械通气患者，这些患者撤机困难，预计需要长时间使用呼吸机。然而，对于哪些患者应转入 LTACH 以及何时转入，存在不同看法。本研究旨在评估气管插管后入住短期急性护理医院（STACH）的时间（LTACH 转移时间）与转入 LTACH 的机械通气患者撤机成功率和死亡率之间的关系。
使用 2014-2015 年医疗保险索赔和评估数据，我们确定了在 STACH 行气管插管并转入 LTACH 且接受长时间机械通气（定义为连续 96 小时或更长时间使用呼吸机）的患者。我们控制了年龄、性别、STACH 入住程序和诊断、Elixhauser 合并症以及 LTACH 质量特征。我们使用工具变量估计来解释未观察到的患者和提供者特征。
本研究队列包括 13622 例 LTACH 病例，LTACH 转移时间中位数为 18 天。LTACH 未调整的呼吸机撤机率为 51.7%，未调整的 90 天死亡率为 43.7%。气管插管后在 STACH 多住一天，撤机的可能性降低 11.6%，这代表在气管插管后 18 天，撤机率降低了 2.5 个百分点。我们没有发现 LTACH 转移时间与 90 天死亡率之间存在统计学显著关系。
将机械通气患者更早从 STACH 转移到 LTACH，与接受长时间机械通气的 LTACH 患者的撤机可能性增加有关。我们的研究结果表明，延迟将机械通气患者转至 LTACH，可能会对患者脱离呼吸机的机会产生负面影响。
