Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease

Abstract

Rationale: Characterization of the dynamic nature of posthospital risk in chronic obstructive pulmonary disease (COPD) is needed to provide counseling and plan clinical services.

Objectives: To analyze risk of readmission and death after discharge for COPD among Medicare beneficiaries aged 65 years and older and to determine the association between ventilator support and risk trajectory.

Methods: We computed daily absolute risks of hospital readmission and death for 1 year after discharge for COPD, stratified by ventilator support. We determined the time required for risks to decline by 50% from maximum daily values after discharge and for daily risks to plateau. We compared risks with those found in the general elderly population.

Measurements and main results: Among 2,340,637 hospitalizations, the readmission rate at 1 year was 64.2%, including 63.5%, 66.0%, and 64.1% among those receiving invasive, noninvasive, and no ventilation, respectively. Among 1,283,069 hospitalizations, mortality at 1 year was 26.2%, including 45.7%, 41.8%, and 24.4% among those same respective groups. Daily risk of readmission declined by 50% within 28, 39, and 43 days and plateaued at 46, 54, and 61 days among those receiving invasive, noninvasive, and no ventilation, respectively. Risk of death declined by 50% by 3, 4, and 17 days and plateaued by 21, 18, and 24 days in the same respective groups. Risks of hospitalization and death were significantly higher after discharge for COPD than among the general Medicare population.

Conclusions: Discharge from the hospital is associated with prolonged risks of readmission and death that vary with need for ventilator support. Interventions limited to the first month after discharge may be insufficient to improve longitudinal outcomes.

Keywords: artificial respiration; chronic obstructive pulmonary disease; mortality; noninvasive ventilation; patient readmission.

Figure 1.

Daily risks of first readmission to the hospital for a 1-year period after hospitalization for chronic obstructive pulmonary disease, according to degree of ventilatory support. IMV = invasive mechanical ventilation; NIV = noninvasive ventilation.

Figure 2.

Daily risks of death for a 1-year period after hospitalization for chronic obstructive pulmonary disease, according to degree of ventilatory support. IMV = invasive mechanical ventilation; NIV = noninvasive ventilation.

Figure 3.

Age–sex–race–adjusted relative risk of readmission in the first year after hospitalization for chronic obstructive pulmonary disease. IMV = invasive mechanical ventilation; NIV = noninvasive ventilation.

Figure 4.

Age–sex–race–adjusted relative risk of death in the first year after hospitalization for chronic obstructive pulmonary disease. IMV = invasive mechanical ventilation; NIV = noninvasive ventilation.