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Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease.

ABSTRACT: BACKGROUND AND AIMS:Patients discharged after treatment for acute exacerbation of chronic obstructive pulmonary disease (COPD) are at high risk for readmission. We aimed to identify the prevalence and risk factors for readmission. METHODS:We included 16,105 patients who had claimed their medical expenses from 1 May 2014 to 1 May 2016 after discharge from any medical facility in Korea, following treatment for acute exacerbation of COPD. We analysed the potential risk factors for readmission within 30?days of discharge. RESULTS:Readmission rate was 26.4% (3989 patients among 15,101 patients) and over 50% of readmissions occurred within 10?days of discharge. Approximately 57% of readmissions occurred due to respiratory causes. Major causes of readmission were COPD (27%), pneumonia (14.2%), and lung cancer (7.1%), in that order. Patients who were readmitted were male, had more comorbidities and were less frequently admitted to tertiary hospitals than those who were not readmitted. Risk factors for readmission within 30?days of discharge were male sex, medical aid coverage, longer hospital stay, longer duration of systemic steroid use during hospital stay, high comorbid condition index, and discharge to skilled nursing facility. CONCLUSION:Readmission occurred in approximately one-quarter of patients, and was associated with patient-related and clinical factors. Using these results, we can identify high-risk patients for readmission and precautions are needed to be taken before deciding on a discharge plan. Further research is needed to develop accurate tools for predicting the risk of readmission before discharge, and development and evaluation of an effective care programme for COPD patients are necessary.The reviews of this paper are available via the supplemental material section.

SUBMITTER: Jo YS

PROVIDER: S-EPMC7580139 | biostudies-literature | 2020 Jan-Dec

REPOSITORIES: biostudies-literature

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Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease.

Jo Yong Suk YS Rhee Chin Kook CK Kim Kyung Joo KJ Yoo Kwang Ha KH Park Yong-Bum YB

Therapeutic advances in respiratory disease 20200101

<h4>Background and aims</h4>Patients discharged after treatment for acute exacerbation of chronic obstructive pulmonary disease (COPD) are at high risk for readmission. We aimed to identify the prevalence and risk factors for readmission.<h4>Methods</h4>We included 16,105 patients who had claimed their medical expenses from 1 May 2014 to 1 May 2016 after discharge from any medical facility in Korea, following treatment for acute exacerbation of COPD. We analysed the potential risk factors for re ...[more]

PMID: 33070701

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Project description:BackgroundReadmissions after exacerbations of chronic obstructive pulmonary disease (COPD) are penalized under the Hospital Readmissions Reduction Program (HRRP). Understanding attributable diagnoses at readmission would improve readmission reduction strategies.ObjectivesDetermine factors that portend 30-day readmissions attributable to COPD versus non-COPD diagnoses among patients discharged following COPD exacerbations.Design, setting, and participantsWe analyzed COPD discharges in the Nationwide Readmissions Database from 2010 to 2016 using inclusion and readmission definitions in HRRP.Main outcomes and measuresWe evaluated readmission odds for COPD versus non-COPD returns using a multilevel, multinomial logistic regression model. Patient-level covariates included age, sex, community characteristics, payer, discharge disposition, and Elixhauser Comorbidity Index. Hospital-level covariates included hospital ownership, teaching status, volume of annual discharges, and proportion of Medicaid patients.ResultsOf 1,622,983 (a weighted effective sample of 3,743,164) eligible COPD hospitalizations, 17.25% were readmitted within 30 days (7.69% for COPD and 9.56% for other diagnoses). Sepsis, heart failure, and respiratory infections were the most common non-COPD return diagnoses. Patients readmitted for COPD were younger with fewer comorbidities than patients readmitted for non-COPD. COPD returns were more prevalent the first two days after discharge than non-COPD returns. Comorbidity was a stronger driver for non-COPD (odds ratio [OR] 1.19) than COPD (OR 1.04) readmissions.ConclusionThirty-day readmissions following COPD exacerbations are common, and 55% of them are attributable to non-COPD diagnoses at the time of return. Higher burden of comorbidity is observed among non-COPD than COPD rehospitalizations. Readmission reduction efforts should focus intensively on factors beyond COPD disease management to reduce readmissions considerably by aggressively attempting to mitigate comorbid conditions.

Project description:BackgroundPatients with chronic obstructive pulmonary disease (COPD) are often readmitted to hospital for treatment due to an acute exacerbation of the disease. However, there are few up-to-date studies investigating the lengths of stay and risk factors for readmission after an acute exacerbation of COPD. This study evaluated the length of stay in patients with an acute exacerbation of COPD and the factors that influenced their readmission.MethodsA search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, carried out using the following search terms: airflow limitation, airway disease, airway obstruction, chronic obstructive pulmonary disease, COPD, length of stay and influencing factors, long-term oxygen therapy, lung disease, readmission, and respiratory system disease. The Cochrane risk of bias tool was used to evaluate the quality of the retrieved studies, and a network meta-analysis was performed using RevMan 5.20.ResultsCollectively, they included information on the length of stay for 630 patients who had been readmitted to hospital after an acute exacerbation of COPD (the readmitted group) and information on 688 patients who had not been readmitted (the non-readmitted group). Meta-analysis results showed that there was no difference in patient anxiety [risk ratio (RR) 1.22, 95% confidence interval (CI): 0.70-2.14] or long-term oxygen therapy (RR 1.91, 95% CI: 0.98-3.73) between the readmitted group and the non-readmitted group. However, there was a significant difference between the forced expiratory volume in one second (FEV1) predicted value [mean difference (MD) -5.85, 95% CI: -11.14 to -0.57] and the global initiative for chronic obstructive lung disease (GOLD) classification (C or D) (RR 1.61, 95% CI: 1.05-2.47).DiscussionIn summary, no significant relationship was found between patient state of anxiety, long-term oxygen therapy, length of hospital stay, and readmission rate after an acute exacerbation of COPD. However, FEV1 predicted values and GOLD classifications (C or D) had an impact on the length of hospital stay and readmission rate after acute exacerbation of COPD. Larger samples, multiple centers, and further research are needed to confirm the findings of this research.

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Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease.

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Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease.

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