Early Readmission Factors in COPD After Hospitalization for Acute Exacerbation

Early readmissions after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) may be characterized by a similar spectrum of diagnoses, according to a study published in the Annals of the American Thoracic Society.

Researchers conducted an analysis of the national readmission database from 2013 to 2014 in an effort to determine the rates, cases, and predictors for early readmissions (3, 7, and 30 days postdischarge) in individuals admitted for acute exacerbations of COPD in the United States.

A total of 202,300 individuals were readmitted to the hospital within 30 days of discharge after a total of 1,055,830 hospitalizations for an acute exacerbation of COPD. 

The rate of readmissions that occurred within 72 hours of discharge was 14.4%, followed by 30% within 7 days, and 58% of readmissions were within 15 days of discharge. The most common reason for readmission and diagnosis were respiratory-related diseases or conditions (52.4%), such as COPD and bronchiectasis (28.4%), respiratory failure (9.5%), pneumonia (7.6%), asthma (7.0%), and congestive heart failure (5.8%).

Other factors associated with an early readmission rate were Medicaid payer status (compared with Medicare; adjusted odds ratio [aOR], 1.09; 95% CI, 1.03-1.16), lower household income ($38,000-$47,999; aOR, 1.09 [95% CI, 1.03-1.15] and ≤$37,999; aOR, 1.11 [95% CI, 1.04-1.17]), higher comorbidity burden (P <.0001), longer length of stay (>5 days vs ≤2 days; aOR, 1.23; 95% CI, 1.17-1.29), and discharge to a skilled nursing facility (aOR, 1.26; 95% CI, 1.19-1.33) or home healthcare (aOR, 1.26; 95% CI, 1.20-1.32). Renal failure and alcohol abuse were the comorbidities with the highest odds of readmission (aOR, 1.16 [95% CI, 1.10-1.22] and aOR, 1.14 [95% CI, 1.06-1.24], respectively).

Researchers concluded that readmission rates were highest during the first 72 hours after admission for an acute exacerbation of COPD, and were most often respiratory-related.

Clinicians should consider these data and note those at higher risk for readmission and consider education material and planning opportunities that could potentially reduce the risk for readmission. Researchers should consider using the readmission risk factors observed in this study to create and test the development of an algorithm that could predict readmissions for an acute exacerbation of COPD.

Reference

Jacobs DM, Noyes K, Zhao J, et al. Early hospital readmissions following an acute exacerbation of COPD in the nationwide readmissions database [published online April 3, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201712-913OC