Abstract Introduction Survivors of acute respiratory distress syndrome (ARDS) experience prolonged recovery marked by recurrent hospitalizations and high healthcare costs. Most ARDS care occurs at large academic centers that serve as referral hubs, yet the impact of hospital teaching status on post-discharge outcomes remains unclear. Identifying these differences may reveal opportunities to enhance survivorship and reduce the long-term burden of critical illness. Methods Using the 2022 Nationwide Readmissions Database, we identified adult hospitalizations with ARDS (ICD-10-CM J80). Hospitals were classified as teaching or non-teaching. Covariates included age, sex, insurance, income quartile, Charlson-derived comorbidity index, hospital bed size, urban-rural status, and use of advanced therapies. Primary outcomes were discharge disposition (home vs post-acute facility) and 30-, 90-, and 180-day readmissions. Secondary outcomes among readmitted patients included in-hospital mortality, length of stay (LOS), and total charges. Multivariable analyses adjusted for demographics, comorbidities, hospital characteristics, and advanced therapies. Results Among 21, 065 ARDS hospitalizations, 77. 3% were in teaching hospitals, predominantly large-bed (79%) and urban (92%) centers. Patients in teaching hospitals were younger (57. 4 vs 60. 4 years; p 0. 001), with similar female representation (43. 1% vs 43. 4%) and slightly higher comorbidity burden (1. 30 vs 1. 26; p = 0. 009). Use of advanced therapies was greater in teaching centers—VV-ECMO 2. 8% vs 2. 6% (p = 0. 19), CRRT 8. 3% vs 4. 8% (p 0. 001), and tracheostomy 15. 3% vs 5. 5% (p 0. 001). Discharge to post-acute facilities was less frequent in teaching hospitals (20. 8% vs 26. 4%; p 0. 001), though teaching status was not independently associated with non-home discharge (aOR 1. 15; p = 0. 12). Predictors included tracheostomy (aOR 3. 73) and CRRT (aOR 1. 45; both p 0. 001). Readmission rates were lower for teaching hospitals at 30 days (22. 7% vs 30. 3%; p 0. 001) but similar by 180 days (23. 1% vs 23. 9%; p = 0. 09). Among readmitted patients, those from teaching hospitals had higher mortality (12. 4% vs 9. 6%; p = 0. 008), longer LOS (8. 0 vs 5. 4 days; p 0. 001), and greater costs (80, 564 vs 59, 314; p 0. 001). Conclusion Most ARDS admissions occur in large, urban teaching hospitals caring for younger yet more comorbid patients with greater use of advanced therapies. While teaching centers had fewer early readmissions, later readmissions were associated with higher mortality, longer stays, and greater costs. These findings highlight that teaching hospitals bear a greater share of post-ARDS recovery and underscore the need for structured transitional-care programs to reduce late mortality and economic strain. This abstract is funded by: None
Khan et al. (Fri,) studied this question.
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