Predictors of Chronic Obstructive Pulmonary Disease (COPD) Readmissions Within 30 Days of Discharge: A Single Center Retrospective Analysis

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Abstract Rationale: Acute exacerbations of COPD (AECOPD) requiring readmission within 30 days result in increased cost and mortality. We aimed at identifying the predictors related to those rehospitalizations in our academic center. Methods: A retrospective study was conducted comparing the demographic and clinical characteristics of patients with AECOPD who were readmitted within 30 days to those who were not; between 11/2020 and 10/2022. A univariate analysis was used to identify factors associated with readmission. Pearson's chi-square test or Fisher's exact test was used for categorical variables, and Welch's two sample t-test was used for continuous variables. Odds ratios and 95% confidence intervals were calculated using Bonferroni corrected adjusted alpha <0.00085 (α=0.05/59). Results: Among 361 patients, 69 (19.1%) were readmitted within 30 days. The average time between admissions was 12.3 ± 6.6 days. Only 35 of the 69 (50.7%) readmissions were due to AECOPD. 199 of the 361 (55%) patients had pulmonary function tests (PFTs) and of those 161 (80%) patients had obstruction. Demographic characteristics, including age at initial admission, gender, and race, were not significantly associated with readmission (Table 1). The highest readmission rates were found among patients with coexisting asthma (OR = 3.32; 95% CI: 1.76-6.18), those with prior admission within the year preceding their initial admission (OR = 5.52; 95% CI: 2.36-16.2), and those previously admitted within one year for COPD-related issues (OR = 3.39; 95% CI: 1.93-6.10). Conversely, patients with history of substance abuse (39/69, or 56.5%; OR = 0.22; 95% CI: 0.13-0.40) or specifically history of tobacco products (26/69, or 27.7%; OR = 0.15; 95% CI: 0.09-0.27) showed lower readmission rates, compared to those without such histories (249/292, or 85.3%; 233/292, or 79.8%, respectively). However, other lifestyle factors, including current smoking status, smoking cessation counseling, chronic oxygen use and various discharge factors, were not associated with readmission. Conclusion: Despite the small readmission cohort size, our data highlights previously described important factors, such as prior admissions within a year and coexistence of asthma as being predictors of readmissions in AECOPD. Interestingly in our population, only half of the patients had documented PFTs and not all had an obstructive pattern. In addition, aligning with the literature only half of readmitted were related to AECOPD.

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