Hospital Discharges, Readmissions, and ED Visits for COPD or Bronchiectasis Among US Adults

Abstract

BACKGROUND Numbers and rates of hospitalizations and ED visits by patients with COPD are important metrics for surveillance purposes. The objective of this study was to examine trends in these rates from 2001 to 2012 among adults aged ≥ 18 years in the United States. METHODS Data from the Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) were examined for temporal trends in the numbers and rates of hospitalizations by patients with COPD or bronchiectasis, mean length of stay, in-hospital case-fatality rate, 30-day readmission rate, and numbers and rates of ED visits. RESULTS The national number of discharges with COPD or bronchiectasis as the principal diagnosis was about 88,000 higher in 2012 than in 2001, but the age-adjusted rate of discharges did not change significantly (range, 242.7-286.0 per 100,000 population, P trend = .554). In contrast, hospitalization rates for common cardiovascular disorders, pneumonia, and lung cancer decreased significantly by 27% to 68%, whereas the mean charge doubled and mean cost increased by 40%. From 2006 to 2011, the numbers of ED visits increased from 1,480,363 to 1,787,612. The age-adjusted rate increased nonsignificantly from 654 to 725 per 100,000 population (P trend = .072). CONCLUSIONS Despite many local and national efforts to reduce the burden of COPD, total hospitalizations and ED visits over the past decade have increased for COPD, and the age-adjusted rates of hospitalizations and ED visits for COPD or bronchiectasis have not changed significantly in the United States.

Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study

“…7% for acute lower respiratory infection or acute exacerbation for COPD in New Zealand 61 and also 7% for COPD or bronchiectasis in the USA), 59 showing that readmissions within 30 days for the index condition comprise about one-third of the total, as in our study.…”

“…51,55 We found that one in five HF and one in six COPD patients were readmitted for any cause within 30 days of live index discharge. These rates are slightly lower than those reported for the US Medicare population (25% for HF 57 and 20% for COPD 58 ) or 21% from the wider US population using the Nationwide Inpatient Sample, 59 although much lower rates have been reported for a private insurance plan in the USA (8%).…”

Impact and prevention of severe exacerbations of COPD: a review of the evidence

“…Despite trends toward an improvement in in-hospital mortality rates and a reduction in average length of hospital stay in the US,9,48 there has been no significant improvement in other indicators, including the number of hospital discharges, emergency-department visits, and 30-day readmissions within the period 2001–2012,48 highlighting considerable room for improvement and opportunities for reduction in the costs associated with admissions for COPD exacerbations. Patients who have been admitted to hospital for a severe exacerbation of COPD are at substantial risk for rehospitalization,19 with up to a quarter of patients readmitted for COPD exacerbations within 1 year following discharge 9,19.…”

The Association Between Rate and Severity of Exacerbations in Chronic Obstructive Pulmonary Disease: An Application of a Joint Frailty-Logistic Model

“…COPD is the third leading cause of years of life lost in the United States (2), and evidence suggests that its burden in comparison with other common chronic diseases is increasing (3). The main symptoms of COPD include shortness of breath, cough, and sputum (4).…”