Variation in length of hospital stay in patients with community-acquired pneumonia: Are shorter stays associated with worse medical outcomes?

PURPOSE: To assess the variation in length of stay for patients hospitalize d with community-acquired pneumonia and to determine whether patients who a re treated in hospitals with shorter mean stays have worse medical outcomes . SUBJECTS AND METHODS: We prospectively studied a cohort of 1,188 adult pati ents with community-acquired pneumonia who had been admitted to one communi ty and three university teaching hospitals. We compared patients' mean leng th of stay, mortality, hospital readmission, return to usual activities, re turn to work, and pneumonia-related symptoms among the four study hospitals . All outcomes were adjusted for baseline differences in severity of illnes s and comorbidity. RESULTS: Adjusted interhospital differences in mean length of stay ranged f rom 0.9 to 2.3 days (P <0.001). When the risk of each medical outcome was c ompared between patients admitted to the hospital with the shortest length of stay and those admitted to longer stay hospitals, there were no differen ces in mortality [relative risk (RR) = 0.7; 95% CI, 0.3 to 1.7], hospital r eadmission (RR = 0.8; 95% CI, 0.5 to 1.2), return to usual activities (RR = 1.1; 95% CI, 0.9 to 1.3), or return to work (RR = 1.2; 95% CI, 0.8 to 2.0) during the first 14 days after discharge, or in the mean number of pneumon ia-related symptoms 30 days after admission (P = 0.54). CONCLUSIONS: We observed substantial interhospital variation in the lengths of stay for patients hospitalized with community-acquired pneumonia. The f inding that medical outcomes were similar in patients admitted to the hospi tal with the shortest length of stay and those admitted to hospitals with l onger mean lengths of stay suggests that hospitals with longer stays may be able to reduce the mean duration of hospitalization for this disease witho ut adversely affecting patient outcomes. (C) 1999 by Excerpta Medica, Inc.