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Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012
Javier de Miguel-Díez1, Rodrigo Jiménez-García2, Valentín Hernández-Barrera2
1Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
Insights
Hospital readmissions for COPD exacerbations are common but decreasing. While readmitted patients face higher mortality and costs, overall incidence and mortality rates declined between 2006 and 2012.
Area of Science:
- Pulmonary Medicine
- Health Services Research
Background:
- Hospitalizations for COPD exacerbations are frequent and often followed by readmissions within 30 days.
- Understanding readmission patterns is crucial for patient outcomes and healthcare system efficiency.
Purpose of the Study:
- To analyze trends in COPD readmissions, including incidence, comorbidities, length of hospital stay, costs, and in-hospital mortality.
- To identify factors associated with readmission and in-hospital mortality in COPD patients.
Main Methods:
- Utilized the Spanish National Hospital Discharge Database (2006-2012) for patients aged 40+ hospitalized for acute exacerbation of COPD (AE-COPD).
- Defined readmission as re-hospitalization within 30 days of discharge for AE-COPD.
Main Results:
- 17.53% of AE-COPD hospitalizations were readmissions.
- Risk factors for readmission included older age, male sex, comorbidities, malnutrition, not being obese, respiratory acidosis, and NIV use.
- Readmissions showed higher in-hospital mortality and costs compared to first admissions.
- A significant decrease in readmission incidence and mortality was observed from 2006 to 2012.
Conclusions:
- 30-day hospital readmissions for AE-COPD are prevalent in Spain, impacting patients and the healthcare system.
- Despite high impact, a positive downward trend in readmission incidence and mortality was noted between 2006 and 2012.
Background And Objective:
Hospitalizations are not isolated events in COPD patients. A significant percentage of patients are readmitted during the first month after their discharge. The aim of this study was to elucidate changes in the incidence, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients readmitted following an initial hospitalization by acute exacerbation of COPD (AE-COPD).
Methods:
We selected all patients ≥40 years, hospitalized for AE-COPD between 2006 and 2012 in Spain using the National Hospital Discharge Database. Patient readmissions were defined as inpatient re-hospitalization within 30 days of discharge for AE-COPD.
Results:
We identified 301 794 discharges of patients having hospital admissions for AE-COPD as their primary diagnosis (82.47% first admissions, 17.53% hospital readmissions). The risk of re-hospitalization was higher in patients aged 65 to 84 years, males, with comorbidities, malnutrition, not obese, respiratory acidosis, treated with non-invasive ventilation (NIV) or discharged to a health/social institutions. Factors associated with IHM among patients readmitted were: older age, increased Charlson Index, malnutrition, not being obese, respiratory acidosis and treatment with NIV. The IHM and hospital costs were significantly higher in readmissions compared with first admissions. We observed that the incidence and mortality of readmissions had significantly decreased from 2006 to 2012.
Conclusion:
Hospital readmissions within 30 days of discharge for AE-COPD are common in Spain. They have a high impact for COPD patients and health system. However, we have found a downward trend in incidence and mortality of readmissions from 2006 to 2012.
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