Specialty-led inpatient chronic obstructive pulmonary disease management and mortality: a propensity-weighted cohort study

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Background: Chronic obstructive pulmonary disease (COPD) is a major cause of hospitalization and mortality. Outcomes may vary by admitting specialty due to differences in expertise and adherence to evidence-based care. This study assessed whether specialty-led management influences inpatient outcomes for COPD exacerbations after adjusting for selection bias using propensity weighting. Methods: This retrospective cohort study was conducted for adults aged ≥40 years admitted with COPD exacerbations between January 2017 and March 2025. Patients with asthma, bronchiectasis, or direct intensive care unit (ICU) admissions were excluded. Data were extracted from electronic health records. Propensity scores derived from demographic and clinical covariates [age, gender, body mass index, comorbidities, smoking status, admission saturation of peripheral oxygen (SpO2), and influenza vaccination status] were used to generate inverse probability of treatment weighting (IPTW) to balance respiratory medicine (RM) and internal medicine (IM) groups. Outcomes included all cause in-hospital mortality, hospital length of stay (LOS), non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) ventilatory support use, and 30-/90-day readmissions. Results: Among 6,277 admissions (51.2% RM, 48.8% IM), IPTW achieved covariate balance in 1,034 COPD patients, comprising 516 RM and 518 IM. RM-led care was associated with lower in-hospital mortality [7.9% vs. 18.0%; odds ratio (OR), 0.38; 95% confidence interval (CI): 0.23–0.62; P=0.001] and shorter LOS (8.0±11.3 vs. 10.4±12.2 days; P=0.001). IM patients required more NIV (26.4% vs. 6.6%; OR, 4.08; P=0.001) and IMV (29.0% vs. 7.2%; OR, 4.49; P=0.001), while 30- and 90-day readmission rates were comparable. Conclusions: After propensity weighting, RM-led inpatient care remained associated with lower mortality and shorter LOS despite less ventilatory support use. These findings reinforce the benefit of specialty-driven management and support integration of respiratory expertise into general medical workflows to improve inpatient COPD outcomes.

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