INCIDENCE AND IMPACT OF COPD READMISSION ON OUTCOMES AND RESOURCE UTILIZATION: A ONE-YEAR FOLLOW UP STUDY

Abstract

SESSION TITLE: Monday Electronic Posters 5 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) affects more than 16 million adults in the United States and is the 3rd leading cause of mortality. The national treatment guidelines stress the importance of controlling COPD to prevent unplanned admissions as a key measure to improving outcomes. The aim of this study was to determine the 1-year readmission rate after a hospitalization for COPD exacerbation, its predictors and its impact on mortality and healthcare resource utilization. METHODS: This is a retrospective cohort study using the National Readmission Database 2016. Patients were included if they had a principal diagnosis of acute COPD exacerbation during the month of January. Patients were excluded if they were younger than 18 years. A readmission was defined as another admission to any hospital for COPD exacerbation within 11 months after discharge. The primary outcome was 1-year COPD-specific readmission. The secondary outcomes were: 1) cumulative resource utilization secondary to readmissions (length of stay (LOS), total hospitalization charges and costs) and 2) independent predictors of readmission, which were identified using multivariate Cox regression analysis. RESULTS: 58,822 patients were included in the study. The mean age was 68 (67-69) years and 58% of patients were Female. The COPD-specific 1-year readmission rate was 29%, with a mean per-patient readmission number of 1.92 (range: 1-6). The in-hospital 1-year mortality rate increased significantly for readmitted patients (1.18% versus 5.94%, p<0.01). In addition, 1-year readmission for patients admitted in January alone was associated with a cumulative LOS of 304,230 days, with a corresponding total hospitalization costs and charges of $625 million and $2.55 billion, respectively. The following factors were independent predictors of readmission: younger age (aHR: 1.02, p<0.01), low household income (aHR:1.11, p<0.01), Medicaid (aHR:1.17, p<0.01), leaving against medical advice (aHR:1.29, p<0.01), prolonged LOS (aHR:1.01, p<0.01) and being treated at high-volume (aHR:1.84, p<0.01), urban teaching (aHR:1.05, p<0.01), and small hospitals (aHR:1.11, p<0.01). CONCLUSIONS: Almost a third of patients admitted with a COPD exacerbation are readmitted in the subsequent 11 months for another exacerbation. These unplanned readmissions have a detrimental effect on patients’ outcomes, with an associated five-fold increase in mortality rates and a staggering healthcare economic burden of $625 million and $2.55 billion in total costs and charges for admissions during the month of January alone. CLINICAL IMPLICATIONS: A concerted effort on the part of the primary care physician, pulmonologist and the patient is needed to keep the patient out of the hospital. We offer multiple independent predictors of readmissions that can be used to identify high-risk patients. DISCLOSURES: No relevant relationships by Jojo Alunilkummannil, source=Web Response No relevant relationships by Abhishek Chakraborti, source=Web Response No relevant relationships by Anantha Sriharsha Madgula, source=Web Response No relevant relationships by Anand Muthu Krishnan, source=Web Response No relevant relationships by Rudra Ramanathan, source=Web Response