title: Rising total costs and mortality rates associated with admissions due to COPD exacerbations.
abstract: To examine trends in mortality, costs and in-hospital management and outcomes of severe COPD exacerbations admitted in France.
  
  
  
  Patients hospitalized from 2007 to 2012 with COPD exacerbation as the primary diagnosis were identified from the exhaustive French medico-administrative hospitalizations database records. Four groups of severe COPD exacerbations were defined: hospitalisation in a general ward (GW) without acute respiratory failure (ARF), GW with ARF, ICU without invasive mechanical ventilation (MV), and ICU with MV.
  
  
  
  A 15.48 % increase in admissions from 113 276 in 2007 to 133 497 in 2012 was recorded. Age (+9.9 months), gender (-2.5 % of male) and length of stay (-0.29 day) slightly changed while the number of ICU admissions increased markedly (+41.78 %). In-hospital mortality rates increased (+8.06 %, p < .001) and followed seasonal variations peaking in winter. Total hospitalizations costs increased from 602 to 678 millions euros (+12.6 %). Pneumonia-related mortality increased (+37.2 %). A progressive replacement of chest X-ray by CT scan was observed (-41.3 % vs +31.7 %) while fewer spirometries (-13.7 %) and bronchoscopies (-22.6 %) were performed.
  
  
  
  The incidence of severe COPD exacerbations and the proportion of ICU-managed patients are still increasing in France. Rising total costs and mortality rates especially related to pneumonia advocate for rethinking COPD management plans.
  
  
  
  Not applicable.
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier hospital, Montpellier, France.|Apard, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: INSERM CNRS U 1067 UMR7733, Université Aix-Marseille, Marseille, France.|Département des Maladies Respiratoires APHM, Laboratoire INSERM U1067, CNRS UMR 7333, Université Aix-Marseille, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chanez
authors.affiliation: Service de Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, AP-HP, Université Paris Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier hospital, Montpellier, France.
authors.forename: Engi
authors.initials: E
authors.lastname: Ahmed
authors.affiliation: Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vachier
authors.affiliation: PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier hospital, Montpellier, France. a-bourdin@chu-montpellier.fr.|Apard, Montpellier, France. a-bourdin@chu-montpellier.fr.|Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France. a-bourdin@chu-montpellier.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics*; D017064:Process Assessment, Health Care / Q000191:economics* / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D012042:Registries; D012121:Respiration, Artificial / Q000191:economics; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Admissions; COPD exacerbation; COPD management; Deaths; Hospitalizations