title: Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel-Díez
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco-Garrido
authors.affiliation: Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Puente Maestu
authors.affiliation: Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Ramírez García
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: López de Andrés
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology
keywords: COPD; admission; exacerbation; readmission; trend