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, and
Jerry A Krishnan
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 guidelines, 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. Key words: hypoxemia; Long COVID; SARS-CoV-2l; post-acute sequelae of SARS-CoV-2;
durable medical equipment. [Respir Care 2024;69(3):281–289. © 2024 Daedalus Enterprises]
Introduction
The consequences of COVID-19, caused by SARSCoV-2, can vary from mild or asymptomatic disease to
acute respiratory failure and death. Since the start of the
COVID-19 pandemic in March 2020,1 there have been
over 6.4 million hospitalizations and 1.1 million deaths
due to COVID-19 in the United States alone (https://
covid.cdc.gov/covid-data-tracker/#datatracker-home.