Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study

Michael B. Freedman; Yoo Jin Kim; Ramandeep Kaur; Bijal V. Jain; Ayodeji O. Adegunsoye; Yu Che Chung; Julie A. Delisa; Jessica M. Gardner; Howard S. Gordon; Jared A. Greenberg; Malvika Kaul; Nader Khouzam; Stephanie L. Labedz; Babak Mokhlesi; Jacob Rintz; Israel Rubinstein; Analisa Taylor; David L. Vines; Lubna Ziauddin; Lynn B. Gerald; Jerry A. Krishnan

doi:10.4187/respcare.11436

Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study

Michael B. Freedman^*, Yoo Jin Kim, Ramandeep Kaur, Bijal V. Jain, Ayodeji O. Adegunsoye, Yu Che Chung, Julie A. Delisa, Jessica M. Gardner, Howard S. Gordon, Jared A. Greenberg, Malvika Kaul, Nader Khouzam, Stephanie L. Labedz, Babak Mokhlesi, Jacob Rintz, Israel Rubinstein, Analisa Taylor, David L. Vines, Lubna Ziauddin, Lynn B. GeraldJerry A. Krishnan

^*Corresponding author for this work

Medicine, Hospital Medicine Division

Research output: Contribution to journal › Editorial › peer-review

1 Scopus citations

Abstract

BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15–37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guide-lines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020–September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22–29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02–1.02]), higher body mass index (aOR 1.02 per kg/m² [1.00–1.04]), diabetes (yes vs no, aOR 1.73 [1.46–2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19–4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51–208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66–0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 41 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.

Original language	English (US)
Pages (from-to)	281-289
Number of pages	9
Journal	Respiratory care
Volume	69
Issue number	3
DOIs	https://doi.org/10.4187/respcare.11436
State	Published - Mar 1 2024

Funding

This work was funded by the National Heart, Lung, and Blood Institute grant number T32HL144909 (Dr Freedman) and the Clinical and Translational Science Award Program grant number UL1TR002003 (University of Illinois Chicago Center for Clinical and Translational Science). The funders of this work had no role in study design, data collection and analysis, preparation of the manuscript, or decision to publish.

Keywords

durable medical equipment
hypoxemia
Long COVID
post-acute sequelae of SARS-CoV-2
SARS-CoV-2l

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.4187/respcare.11436

Cite this

Freedman, M. B., Kim, Y. J., Kaur, R., Jain, B. V., Adegunsoye, A. O., Chung, Y. C., Delisa, J. A., Gardner, J. M., Gordon, H. S., Greenberg, J. A., Kaul, M., Khouzam, N., Labedz, S. L., Mokhlesi, B., Rintz, J., Rubinstein, I., Taylor, A., Vines, D. L., Ziauddin, L., ... Krishnan, J. A. (2024). Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study. Respiratory care, 69(3), 281-289. https://doi.org/10.4187/respcare.11436

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title = "Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study",

abstract = "BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15–37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guide-lines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020–September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22–29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02–1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00–1.04]), diabetes (yes vs no, aOR 1.73 [1.46–2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19–4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51–208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66–0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 41 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.",

keywords = "durable medical equipment, hypoxemia, Long COVID, post-acute sequelae of SARS-CoV-2, SARS-CoV-2l",

author = "Freedman, {Michael B.} and Kim, {Yoo Jin} and Ramandeep Kaur and Jain, {Bijal V.} and Adegunsoye, {Ayodeji O.} and Chung, {Yu Che} and Delisa, {Julie A.} and Gardner, {Jessica M.} and Gordon, {Howard S.} and Greenberg, {Jared A.} and Malvika Kaul and Nader Khouzam and Labedz, {Stephanie L.} and Babak Mokhlesi and Jacob Rintz and Israel Rubinstein and Analisa Taylor and Vines, {David L.} and Lubna Ziauddin and Gerald, {Lynn B.} and Krishnan, {Jerry A.}",

year = "2024",

month = mar,

day = "1",

doi = "10.4187/respcare.11436",

language = "English (US)",

volume = "69",

pages = "281--289",

journal = "Respiratory care",

issn = "0020-1324",

publisher = "Daedalus Enterprises Inc.",

number = "3",

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Freedman, MB, Kim, YJ, Kaur, R, Jain, BV, Adegunsoye, AO, Chung, YC, Delisa, JA, Gardner, JM, Gordon, HS, Greenberg, JA, Kaul, M, Khouzam, N, Labedz, SL, Mokhlesi, B, Rintz, J, Rubinstein, I, Taylor, A, Vines, DL, Ziauddin, L, Gerald, LB & Krishnan, JA 2024, 'Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study', Respiratory care, vol. 69, no. 3, pp. 281-289. https://doi.org/10.4187/respcare.11436

TY - JOUR

T1 - Home Oxygen After Hospitalization for COVID-19

T2 - Results From the Multi-Center OXFORD Study

AU - Freedman, Michael B.

AU - Kim, Yoo Jin

AU - Kaur, Ramandeep

AU - Jain, Bijal V.

AU - Adegunsoye, Ayodeji O.

AU - Chung, Yu Che

AU - Delisa, Julie A.

AU - Gardner, Jessica M.

AU - Gordon, Howard S.

AU - Greenberg, Jared A.

AU - Kaul, Malvika

AU - Khouzam, Nader

AU - Labedz, Stephanie L.

AU - Mokhlesi, Babak

AU - Rintz, Jacob

AU - Rubinstein, Israel

AU - Taylor, Analisa

AU - Vines, David L.

AU - Ziauddin, Lubna

AU - Gerald, Lynn B.

AU - Krishnan, Jerry A.

PY - 2024/3/1

Y1 - 2024/3/1

N2 - BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15–37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guide-lines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020–September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22–29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02–1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00–1.04]), diabetes (yes vs no, aOR 1.73 [1.46–2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19–4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51–208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66–0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 41 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.

AB - BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15–37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guide-lines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020–September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22–29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02–1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00–1.04]), diabetes (yes vs no, aOR 1.73 [1.46–2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19–4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51–208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66–0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 41 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.

KW - durable medical equipment

KW - hypoxemia

KW - Long COVID

KW - post-acute sequelae of SARS-CoV-2

KW - SARS-CoV-2l

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DO - 10.4187/respcare.11436

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AN - SCOPUS:85186195832

SN - 0020-1324

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Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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