Among patients with chronic obstructive pulmonary disease (COPD) exacerbations, readmission to a different hospital is associated with higher mortality, increased hospital length of stay (LOS), and increased cost of hospitalization, according to a study being presented at the CHEST Annual Meeting 2019.
Researchers collected information on readmission for patients with COPD-related hospitalization from the Nationwide Readmission Database for the year 2014. They categorized 30-day readmissions as return to same versus different hospital. A total of 949,830 index COPD admissions were identified, 255,338 (26.8%) of which were readmitted within 30 days. In this cohort, 21.9% of readmissions were to a different hospital, while 78.1% were to the same hospital.
Predictors of readmission to a different hospital included younger age (odds ratio [OR], 0.986; 95% confidence interval [CI], 0.984-0.988; P<0.001) and male sex (OR, 1.16; 95% CI, 1.11-1.21; P<0.001). A predictor of readmission to the same hospital was higher median household income (OR, 0.89; 95% CI, 0.81-0.99; P<0.03).
Elective readmissions accounted for 5.1% of total readmissions and were more common among patients readmitting to a different hospital (OR, 1.55; 95% CI, 1.41-1.71; P<0.001). Median time to readmission was 13.5 days, and comorbidities were similar in both cohorts.
Readmission to a different hospital resulted in increased in-hospital mortality (7.6% vs. 6.7%; P<0.001; OR, 1.13; 95% CI, 1.06-1.21; P<0.001), increased hospital LOS (6.99 vs. 6.08; P<0.001; 95% CI, 0.84-0.97), and increased cost of hospitalization ($60,569 vs. $47,335; P<0.001; 95% CI, 12,375-14,093).
“Continuity of care in COPD can allow physicians to offer patients a [timelier] diagnosis and appropriate management,” the authors concluded. “Allocating resources to minimize different hospital COPD readmissions can result in improved outcomes and limit its high cost on the healthcare system.”
- Shammaa Y, Mansour W, Karam B, et al. COPD readmission outcomes: same-hospital vs different hospital. Presented at the CHEST Annual Meeting 2019. October 19-23, 2019; New Orleans, Louisiana.