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Obstructive Lung Diseases |

30-Day Readmissions in Patients Hospitalized With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Shadi Hijjawi, MD; Marwan Abu Minshar, MD; Yue Wang, MS; Gulshan Sharma*, MD
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UTMB, Galveston, TX


Chest. 2012;142(4_MeetingAbstracts):738A. doi:10.1378/chest.1390319
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Abstract

SESSION TYPE: COPD: Diagnosis and Evaluation

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: COPD is the third most common cause of 30-day readmission. Readmissions are costly and attributed to poor quality of care. National efforts are geared toward reducing 30-day readmission. However there are no validated risk prediction models for patients with COPD to predict 30-day readmissions and / or interventions to reduce these readmissions. We examined 30 day readmission and factors associated with early readmission in patients hospitalized with AECOPD. Our hypothesis was early readmissions among patients with COPD are not preventable.

METHODS: We performed a retrospective chart review of all patients with primary discharge diagnosis of COPD based on ICD-9 code 491, 492 and 496.0 between 6/1/2010 to 5/30/2011. Detailed information on patient characteristics was obtained from electronic medical record to confirm the diagnosis of AECOPD. Patients were followed up to 30 days post discharge date for readmission. We examined the difference in baseline characteristics of patient who were readmitted with those who were not readmitted within 30-days. T-test and chisq test were used to compare continuous and categorical variables, respectively. A multivariate GEE model to adjust for clustering at patient level was used to examine the factors associated with 30-day readmission. All p-value <0.05 was considered statisticaly significant.

RESULTS: 160 patients were admitted for a total of 193 hospitalizations during the study period. Of these 30 patients (18.8%) were re-admitted within 30 days. Patients who were readmitted were more likely to be black, had congestive heart failure, coronary artery disease, h/o alcohol abuse, and were on supplement oxygen. There was no difference in baseline medication use, length of stay, or serum bicarbonate, and whether or not the patient had a follow up post discharge. In a multivariate analysis, odds of 30-day readmission was 2.56 (95% CI: 1.18-5.38) in patients on supplement oxygen, and 2.17 (95% CI; 1.16-4.09) in patients with alcohol abuse.

CONCLUSIONS: In our study population 30-day readmission in patients with COPD were related to advanced disease and psychosocial factors which are unlikely to be modifiable.

CLINICAL IMPLICATIONS: Early readmissions in patients with COPD are not preventable.

DISCLOSURE: The following authors have nothing to disclose: Shadi Hijjawi, Marwan Abu Minshar, Yue Wang, Gulshan Sharma

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UTMB, Galveston, TX

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