Role of Pulmonary Hypertension in Acute Exacerbation of Chronic Obstructive Pulmonary Disease; Outcomes and Healthcare Utilization

Abstract

<h3>Purpose</h3> Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). Mortality in COPD and PH has significantly improved due to advances made in the field, however, the effect of PH during acute exacerbation of COPD (AECOPD) remains unknown. We aim to analyze the outcomes, 30-day readmission rates, and healthcare resource utilization associated with PH in patients with AECOPD. <h3>Methods</h3> We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and PH as a secondary diagnosis using ICD 10-CM codes. Exclusion criteria were age under 18 years, non-elective admissions to better assess readmission rates and discharges in December. The primary outcome was in-hospital mortality during the index admission. Secondary outcomes were 30-day readmission rate, Length of stay (LOS), resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96hr (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. <h3>Results</h3> A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90 %) patients had a diagnosis of PH. PH was more common among females (61.14%) with a mean age of 71 ±11.66, Medicare recipients (79.5%), higher Charlson Comorbidity Index, and treatment in an urban teaching hospital. PH was associated with greater in-hospital mortality [Adjusted odds ratio (aOR): 1.89, p<0.001], higher 30-day readmission (aOR: 1.24, p<0.001), higher LOS [adjusted mean difference (aMD): 1.09, p<0.001], higher cost (aMD: $2785, p<0.01), and higher instrument utilization including intubation (aOR: 1.99, p<0.001), PIMV (aOR: 2.12, p<0.001), tracheostomy (aOR: 2.15, p<0.001), bronchoscopy (aOR:1.46, p=0.007) and chest tube placement (aOR: 1.39 p<0.004). <h3>Conclusion</h3> Our study indicates that PH is associated with greater in-hospital mortality, LOS, and 30-day readmission among patients with AECOPD. It is also associated with increased procedure utilization and higher healthcare resource utilization leading to increased hospital expenses. These factors lead to a detrimental effect on a patient's well-being and impact their quality of life. Prompt diagnosis and appropriate treatment of PH in patients with COPD may improve outcomes in these patients.