.jpg "Kejal Gandhi, MBBS photo")
Kejal Gandhi, MBBS
Resident Physician
MedStar Washington Hospital Center
Washington, District of Columbia
Disclosure information not submitted.
Nikitha Vobugari, MBBS
Resident Physician
Georgetown University/Medstar Washington Hospital Center, United States
Disclosure information not submitted.
Pahnwat Taweesedt, MD
Pulmonary/Critical Care Fellow
James J Peters VA Medical Center, United States
Disclosure information not submitted.
Salim Surani, MD, M.P.H., MSHM
Adjunct Clinical Professor
Executive Medical Clinic, United States
Disclosure information not submitted.
Title: Palliative Care Causes Higher Mortality among Oxygen-Dependent COPD Patietns: Is it True?
Objective: To evaluate in-hospital outcomes in COPD patients dependent on home oxygen who receive palliative care consult.
Background: National Inpatient Sample (NIS) database is used extensively to answer questions. COPD patients are less likely referred to palliative care compared to patients with heart failure or cancer. Limited data is available on outcomes in end-stage COPD patients receiving palliative care.
Methods: The NIS database from the year 2015-2018 was used to compare the COPD patients dependent on home oxygen who received palliative care consult vs who did not. The primary outcome was in-hospital mortality. The secondary outcome included non-invasive ventilation, invasive ventilation and do not resuscitate (DNR) status.
Results: A total of 3,323,978 patients with COPD dependent on home oxygen were included. Only 213,594 (6%) patients received palliative care versus 3,110,383 (94%) patients who did not. Patient referred to palliative care were older (mean age of 73 vs 69 years) and more likely to have metastatic cancer (14.6% vs 2.9%), solid tumor with metastasis (21.3% vs 6.6%), pulmonary circulation disorders (23% vs 18.7%), and pneumonia (24.6% vs 18.9%), with p-value < 0.001. Palliative care consultation increased by five-fold in year 2018 (33%) compared to year 2015 (6%). The unmatched total charges for patients with palliative care were $46378 compared to $40393. Median length of stay in palliative care group was 5 days compared to 4 days in other group.
After propensity matching for covariables, patients with palliative care referral have higher mortality (31% vs 3%), underwent more invasive ventilation (16.2% vs 7%) and non-invasive ventilation (19.3 vs 10.7%). Patients with palliative care consults are more likely to have DNR status (71% vs 17.9%).
Conclusion: It seems that palliative care is associated with higher cost, length of stay and mortality. In this nationwide observational study, only 6% of deserving population received palliative care. It suggests that these patients tend to be sicker resulting in higher mortality, invasive and non-invasive ventilation. DNR status is significantly higher in patients receiving palliative care. This abstract shows that caution should be undertaken in interpreting the information from NIS database. Asking right question is the key.