Risk factors and outcomes associated with chronic obstructive pulmonary disease exacerbations requiring hospitalization.
BACKGROUND
Acute respiratory exacerbations are the most frequent cause of medical visits, hospitalization and death for chronic obstructive pulmonary disease (COPD) patients and, thus, exert a significant social and economic burden on society.


OBJECTIVE
To identify the risk factors associated with hospital readmission(s) for acute exacerbation(s) of COPD (AECOPD).


METHODS
A review of admission records from three large urban hospitals in Vancouver, British Columbia, identified 310 consecutive patients admitted for an AECOPD between April 1, 2001, and December 31, 2002. Logistic regression analysis was performed to identify risk factors for readmissions following an AECOPD.


RESULTS
During the study period, 38% of subjects were readmitted at least once. The mean (+/- SD) duration from the index admission to the first readmission was 5+/-4.08 months. Comparative analysis among the three hospitals identified a significant difference in readmission rates (54%, 36% and 18%, respectively). Logistic regression analysis revealed that preadmission home oxygen use (OR 2.55; 95%CI 1.45 to 4.42; P=0.001), history of a lung infection within the previous year (OR 1.73; 95% CI 1.01 to 2.97; P=0.048), other chronic respiratory disease (OR 1.78; 95% CI 1.06 to 2.99; P=0.03) and shorter length of hospital stay (OR 0.97; 95% CI 0.945 to 0.995; P=0.021) were independently associated with frequent readmissions for an AECOPD.


CONCLUSIONS
Hospital readmission rates for AECOPD were high. Only four clinical factors were found to be independently associated with COPD readmission. There was significant variability in the readmission rate among hospitals. This variability may be a result of differences in the patient populations that each hospital serves or may reflect variability in health care delivery at different institutions.
Bahadori
Katayoun
K
Vancouver Coastal Health Research Institute and Respiratory Medicine, Vancouver General Hosptial, Vancouver, Canada.
FitzGerald
J Mark
JM
Levy
Robert D
RD
Fera
Tharwat
T
Swiston
John
J
D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
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