Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012

Abstract

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.

Keywords: COPD; admission; exacerbation; readmission; trend.