Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

Abstract

BackgroundReadmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.MethodsWe systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.ResultsIn total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22–1.37)), renal failure (1.26 (1.19–1.33)), depression (1.19 (1.05–1.34)) and alcohol use (1.11 (1.07–1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88–0.94)).ConclusionsComorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.

<p>Global Current Practices of Ventilatory Support Management in COVID-19 Patients: An International Survey</p>

“…61,62 Generally, most of these barriers or limitations are modifiable, while the reminder needs a holistic approach for better management of patient-related factors such as multimorbidity. 63 In general, there are significant differences in the types of limitations between continents which is linked to regional lapses in the handling of the COVID-19 pandemic and outcomes. Critical evaluation and resolution of those modifiable limitations would help regions around the world to better prepare for future pandemics.…”

National clinical audit for hospitalised exacerbations of COPD

“…Initial COPD exacerbation diagnoses may change and an initial alternative diagnosis may be amended to a diagnosis of COPD exacerbation complicating early review. Readmissions are a particularly challenging outcome to modify, reflecting care delivered during the index event and following discharge by primary and community teams, and to a certain extent part of the natural history of COPD with a documented increased risk of re-exacerbation in the period following recovery from a first exacerbation [ 36 ] and the presence of comorbidity [ 37 ]. Future audit might capture outcomes that are more sensitive to change, such as quality of life and patient experience measures.…”

Diagnostic and clinical values of non-cardiac ultrasound in COPD: A systematic review

“…2 COPD is commonly associated with inevitable multimorbidities linked with frequent readmissions to hospitals and poor outcomes. 3 While our understanding of COPD continues to increase, the contributions of comorbidity, such as muscle wasting to clinical outcome, remain a major challenge.…”