Comparative Analysis of Mortality and Hospital Stay in Non-ICU Admitted Patients: The Impact of a Comprehensive Intervention with Modified Pulmonary Rehabilitation Including Supervised Hydration, Structured Exercise, and Proper Nutritional Intake

Abstract

Background:

Hospitalized patients with respiratory illnesses, even in non-ICU settings, are vulnerable to complications due to inactivity, dehydration, and nutritional deficits. Modified pulmonary rehabilitation (PR), when integrated into inpatient care, may improve outcomes by addressing these factors holistically.

Objectives:

To evaluate the impact of a comprehensive intervention comprising supervised hydration, structured exercise, and nutritional intake on in-hospital mortality and hospital stay in non-ICU patients with respiratory diseases.

Materials and Methods:

This prospective comparative study included 120 adult patients admitted to a tertiary hospital ward, randomized into an intervention group (modified PR) and a control group (standard care). Outcomes assessed included mortality, hospital stay duration, early ambulation, and fatigue levels. Statistical comparisons were performed using t-tests and chi-square analysis.

Results:

In-hospital mortality was significantly lower in the intervention group (3.3%) compared with controls (11.7%, P = 0.04). The mean hospital stay was reduced (5.2 ± 1.4 vs. 7.4 ± 2.1 days, P < 0.001), and early ambulation (78.3% vs. 41.7%) and fatigue scores (3.2 vs. 5.8) showed marked improvement in the intervention group.

Conclusion:

A multidisciplinary, modified PR approach significantly enhances recovery, reduces hospital burden, and improves patient-reported outcomes in non-ICU settings. Its integration into standard ward care should be considered.

INTRODUCTION

Hospitalized patients admitted for respiratory illnesses often experience deconditioning, fluid imbalance, and nutritional deficits, contributing to prolonged hospital stay and increased mortality risk, even in non-ICU settings. While pulmonary rehabilitation (PR) has traditionally been reserved for stable outpatients with chronic respiratory conditions such as COPD, emerging evidence suggests that in-hospital, multidisciplinary interventions can significantly enhance recovery outcomes when tailored to acute care needs.

Modified pulmonary rehabilitation, incorporating early mobilization, structured exercise, hydration management, and nutritional optimization, has been shown to improve functional capacity, reduce systemic inflammation, and lower the incidence of hospital-acquired complications.[1] Supervised hydration helps maintain optimal mucociliary clearance and prevent fluid overload, particularly in elderly or frail patients. In addition, nutritional support tailored to individual caloric and protein needs is critical in preserving lean muscle mass and immune competence during hospitalization.[2]

Structured physical activity, even in low-intensity forms such as bedside cycling or respiratory physiotherapy, has been linked to shorter hospital stays and better postdischarge outcomes.[3] Despite this, there remains limited integration of such comprehensive rehabilitative approaches in general medical wards, particularly in non-ICU patients who are often perceived as clinically stable yet remain at risk for decline.

This study aims to evaluate the impact of a combined intervention program—consisting of supervised hydration, structured exercise, and nutritional intake as part of a modified pulmonary rehabilitation protocol—on mortality and hospital stay duration in non-ICU admitted patients. By comparing outcomes with a matched control group receiving standard care, this study seeks to highlight the potential of low-resource, multicomponent interventions in enhancing inpatient care quality and reducing hospital burden.

MATERIALS AND METHODS

This was a prospective, comparative observational study conducted at a tertiary care hospital over a period of 6 months. The objective was to assess the effect of a comprehensive intervention program—comprising modified pulmonary rehabilitation, supervised hydration, structured exercise, and nutritional support—on in-hospital mortality and duration of hospital stay in non-ICU admitted patients with respiratory conditions.

Study population

The study enrolled 120 adult patients aged 40-80 years admitted to the general medical wards with non-ICU-requiring respiratory illnesses (e.g., moderate COPD exacerbation, pneumonia without respiratory failure, bronchiectasis). Patients were excluded if they were admitted to ICU, had hemodynamic instability, cognitive impairment, or contraindications to exercise or enteral feeding.

Study design

Patients were divided into two groups of 60 each:

• Intervention group: Received a multi-component care package, including:

  • Supervised oral hydration of 2-2.5 liters/day based on weight and comorbidities

  • Twice-daily guided physiotherapy and mobilization exercises

  • Nutritional support with calculated caloric and protein intake based on body weight and disease severity

• Control group: Received standard care without structured interventions.

Data collection

Primary outcomes were mortality during hospital stay and length of hospitalization (in days). Secondary outcomes included early ambulation rates and patient-reported fatigue levels. Data on baseline demographics, comorbidities, and disease severity (BODE index for COPD patients) were also collected.

Statistical Analysis

Descriptive statistics, independent t-tests, and chi-square tests were used to compare outcomes between groups. A P-value < 0.05 was considered statistically significant.

RESULTS

The study compared outcomes between two groups of non-ICU patients receiving either standard care or a comprehensive intervention incorporating modified pulmonary rehabilitation. Baseline characteristics including age, sex, and comorbidities such as COPD, pneumonia, hypertension, and diabetes were statistically comparable between the two groups [Table 1], confirming initial homogeneity.

Table 1.

Baseline demographic and clinical characteristics

Variable		Intervention group (n=60)		Control group (n=60)		P
Mean Age (years)		65.4±8.2		66.1±7.9		0.61
Male (%)		66.7%		68.3%		0.84
COPD (%)		40.0%		38.3%		0.82
Pneumonia (%)		36.7%		35.0%		0.78
Hypertension (%)		46.7%		48.3%		0.89
Diabetes mellitus (%)		41.7%		40.0%		0.81

Clinical outcomes indicated significant benefits in the intervention group. In-hospital mortality was notably lower at 3.3% compared with 11.7% in the control group (P = 0.04), suggesting a protective effect of the intervention. Furthermore, the intervention group had a significantly shorter mean hospital stay (5.2 ± 1.4 days vs. 7.4 ± 2.1 days, P < 0.001), which could indicate better recovery dynamics and lower complication rates. Early ambulation by day 3 was achieved in 78.3% of intervention patients compared with only 41.7% in the control group (P < 0.001), highlighting the importance of early mobilization. In addition, patient-reported fatigue scores were lower in the intervention group (3.2 ± 1.1) compared with the control group (5.8 ± 1.5), reinforcing the positive impact on subjective well-being [Table 2].

Table 2.

Clinical outcomes comparing intervention and control groups

Outcome		Intervention group		Control group		P
In-hospital Mortality		3.3% (2/60)		11.7% (7/60)		0.04*
Mean hospital stay (days)		5.2±1.4		7.4±2.1		<0.001*
Early ambulation by day 3 (%)		78.3%		41.7%		<0.001*
Patient-reported fatigue score (1–10)		3.2±1.1		5.8±1.5		<0.001*

*Significant

DISCUSSION

The findings of this study demonstrate that a comprehensive, modified pulmonary rehabilitation (PR) intervention—comprising supervised hydration, structured exercise, and nutritional optimization—significantly improves clinical outcomes in non-ICU hospitalized patients with respiratory conditions. Compared with standard care, the intervention group showed a statistically significant reduction in in-hospital mortality and mean hospital stay, alongside higher rates of early ambulation and lower fatigue scores.

These results are consistent with prior studies suggesting that early mobilization and structured physical therapy can decrease complications, promote faster functional recovery, and reduce length of stay in hospitalized patients.[4,5] Exercise and ambulation have been shown to maintain muscle mass and prevent deconditioning, particularly in elderly or sedentary patients.[6] Moreover, hydration plays a key role in respiratory clearance and systemic homeostasis, especially in patients prone to dehydration or electrolyte imbalance.[7]

Nutritional support was another cornerstone of our intervention. Several studies have established a direct correlation between nutritional intake and recovery outcomes in both COPD and pneumonia patients.[5,6] Malnutrition is a known risk factor for prolonged hospitalization and higher mortality in acutely ill individuals.[8]

Interestingly, fatigue scores were significantly lower in the intervention group, aligning with evidence that multimodal PR improves not only physical metrics but also perceived well-being and quality of life.[9] This highlights the need for holistic care strategies in general medical wards, not just in rehabilitation or ICU settings.

This study adds to the growing body of literature advocating for the integration of multidisciplinary, low-cost supportive care in noncritical settings. While further multicentric trials are warranted, our findings support early adoption of such protocols in routine clinical practice.

CONCLUSION

This study demonstrates that a comprehensive, modified pulmonary rehabilitation protocol significantly reduces in-hospital mortality and shortens hospital stay among non-ICU patients with respiratory illnesses. Incorporating supervised hydration, structured exercise, and targeted nutritional support into routine ward care enhanced functional recovery and patient well-being. The intervention was simple, cost-effective, and feasible in a general ward setting.

Conflicts of interest

Nil.

Funding Statement

Nil.