In-hospital complications among survivors of admission for congestive heart failure,chronic obstructive pulmonary disease,or diabetes mellitus

OBJECTIVE: To determine the frequency of hospital complications among survivors of inpatient treatment for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or diabetes mellitus (DM). DESIGN: Retrospective cohort study. SETTING: Nine Veterans Affairs hospitals in the southern United States. PATIENTS: 1,837 men veterans discharged alive following hospitalization for CHF, COPD, or DM between January 1987 and December 1989. This patient population represents a subset of cases gathered to study the process of care in the hospital and subsequent early readmission; thus, veterans who died in the hospital were not included. MEASUREMENTS: Medical record review to record the occurrence of any of 30 in-hospital complications such as cardiac arrest, nosocomial infections, or delirium (overall agreement between two reviewers=84%, kappa=0.37). RESISTS: Complications occurred in 15.7% of the CHF cases, 13.1% of the COPD cases, and 14.8% of the DM cases. Hypoglycemic reactions were the most frequent individual adverse events in the CHF and DM cases (3.6% and 11.4% of the cases, respectively), and theophylline toxicity was most frequent among the COPD cases (4.9%). Patient age, the presence of comorbid diseases, and the Acute Physiology Score (APS) of APACHE II were associated with complication occurrence. For each disease, the patients who had a complication had significantly longer mean hospital stays than did the patients who did not have complications (14.6 to 14.9 days vs 7.2 to 8.2 days, p<0.01). CONCLUSIONS: Complications are frequent among patients discharged alive with CHF, COPD, or DM. The patients who experienced complications were more ill on admission and had longer hospital stays. Received from the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center. Baylor College of Medicine, Houston, Texas. Presented in part at the annual meeting of the American Federation for Clinical Research, Washington, DC, May 1, 1993, and the VA HSR & D Career Development Awardees Conference, Washington, DC, April 25, 1994. Supported by the Department of Veterans Affairs, Health Services Research & Development Service, VA HSR & D IIR 89.061.1 (Dr. Ashton), and by a Research Associate Career Development Award (Dr. Geraci).