Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis.
Journal
European respiratory review : an official journal of the European Respiratory Society
ISSN: 1600-0617
Titre abrégé: Eur Respir Rev
Pays: England
ID NLM: 9111391
Informations de publication
Date de publication:
30 Jun 2020
30 Jun 2020
Historique:
received:
27
11
2019
accepted:
18
12
2019
entrez:
6
6
2020
pubmed:
6
6
2020
medline:
7
4
2021
Statut:
epublish
Résumé
Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD. We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model. In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)). Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
Sections du résumé
BACKGROUND
BACKGROUND
Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.
METHODS
METHODS
We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.
RESULTS
RESULTS
In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)).
CONCLUSIONS
CONCLUSIONS
Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
Identifiants
pubmed: 32499306
pii: 29/156/190166
doi: 10.1183/16000617.0166-2019
pmc: PMC9488450
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright ©ERS 2020.
Déclaration de conflit d'intérêts
Conflict of interest: J.S. Alqahtani has nothing to disclose. Conflict of interest: C.M. Njoku has nothing to disclose. Conflict of interest: B. Bereznicki has nothing to disclose. Conflict of interest: B.C. Wimmer has nothing to disclose. Conflict of interest: G.M. Peterson has nothing to disclose. Conflict of interest: L. Kinsman has nothing to disclose. Conflict of interest: Y.S. Aldabayan has nothing to disclose. Conflict of interest: A.M. Alrajeh has nothing to disclose. Conflict of interest: A.M. Aldahahir has nothing to disclose. Conflict of interest: S. Mandal has nothing to disclose. Conflict of interest: J.R. Hurst reports personal fees and non-financial support from pharmaceutical companies that make medicines to treat COPD, outside the submitted work.
Références
Ann Am Thorac Soc. 2017 Aug;14(8):1305-1311
pubmed: 28406710
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
Int J Chron Obstruct Pulmon Dis. 2018 Oct 02;13:3077-3083
pubmed: 30323578
PLoS Med. 2006 Nov;3(11):e442
pubmed: 17132052
BMC Health Serv Res. 2011 Aug 10;11:186
pubmed: 21831287
Ann Am Thorac Soc. 2014 Jun;11(5):685-94
pubmed: 24784958
Int J Chron Obstruct Pulmon Dis. 2018 Dec 18;14:39-49
pubmed: 30587960
Int J Chron Obstruct Pulmon Dis. 2013;8:551-9
pubmed: 24348031
Ann Am Thorac Soc. 2018 Sep;15(9):1033-1038
pubmed: 30079748
PLoS One. 2019 May 21;14(5):e0216741
pubmed: 31112573
Int J Chron Obstruct Pulmon Dis. 2013;8:631-9
pubmed: 24353413
N Engl J Med. 2010 Sep 16;363(12):1128-38
pubmed: 20843247
BMJ. 2017 Jan 31;356:j557
pubmed: 28148489
Postgrad Med. 2015 May;127(4):343-8
pubmed: 25687324
Ann Am Thorac Soc. 2015 Dec;12(12):1805-12
pubmed: 26394180
Int J Chron Obstruct Pulmon Dis. 2007;2(3):241-51
pubmed: 18229562
Respir Med. 2015 Feb;109(2):238-46
pubmed: 25559374
Chest. 2015 May;147(5):1219-1226
pubmed: 25539483
Ann Am Thorac Soc. 2014 Jun;11(5):695-705
pubmed: 24713094
Respir Med. 2017 Sep;130:92-97
pubmed: 29206640
Thorax. 2004 May;59(5):387-95
pubmed: 15115864
Ann Emerg Med. 2012 Jul;60(1):4-10.e2
pubmed: 22418570
Ann Am Thorac Soc. 2019 Feb;16(2):161-170
pubmed: 30707066
Eur Respir J. 2016 Jan;47(1):113-21
pubmed: 26493806
Thorax. 2015 Dec;70(12):1131-7
pubmed: 26283709
Thorax. 2006 Sep;61(9):772-8
pubmed: 16738033
Ann Am Thorac Soc. 2018 Jul;15(7):837-845
pubmed: 29611719
Med Care. 2017 Jul;55 Suppl 7 Suppl 1:S20-S25
pubmed: 28288076
Clin Epidemiol. 2017 Dec 27;10:51-59
pubmed: 29343987
Hosp Pract (1995). 2015;43(4):199-207
pubmed: 26357878
Thorax. 2002 Oct;57(10):847-52
pubmed: 12324669
Clinicoecon Outcomes Res. 2015 Jan 06;7:37-51
pubmed: 25609986
Chest. 2017 Feb;151(2):366-373
pubmed: 27746201
Epidemiology. 2001 Mar;12(2):239-45
pubmed: 11246587
Hosp Pract (1995). 2016 Aug;44(3):123-8
pubmed: 27391991
Eur Respir Rev. 2017 Jan 17;26(143):
pubmed: 28096287
Lancet Respir Med. 2013 Jul;1(5):347
pubmed: 24429186
Am J Manag Care. 2017 Aug 1;23(8):e253-e258
pubmed: 29087152
BMJ. 2014 Jul 08;349:g4315
pubmed: 25004917
Am J Respir Crit Care Med. 2014 Mar 15;189(6):634-9
pubmed: 24460431
Chest. 2014 May;145(5):972-980
pubmed: 24077342
Respir Res. 2019 Aug 16;20(1):186
pubmed: 31420040
Drugs Context. 2015 Mar 18;4:
pubmed: 25834619
Thorax. 2017 Aug;72(8):686-693
pubmed: 28235886
Chronic Obstr Pulm Dis. 2016 Aug 29;3(4):729-738
pubmed: 28848899
Ann Am Thorac Soc. 2014 Oct;11(8):1203-9
pubmed: 25167366
Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582
pubmed: 28128970
Lancet Respir Med. 2018 Mar;6(3):172-174
pubmed: 29433984
Am J Respir Crit Care Med. 2017 Jul 1;196(1):47-55
pubmed: 28145726
Health Policy. 2015 Mar;119(3):264-73
pubmed: 25547401
Respir Med. 2018 Mar;136:1-7
pubmed: 29501240
Chest. 2016 Apr;149(4):905-15
pubmed: 26204260