<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

Abstract

Background and Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities. Methods: In this retrospective cohort study, we used Cox regression to estimate the hazard ratio of 30-day readmission rates for COPD patients who had no comorbidity and those who had one, two or three, or four or more comorbidities. We controlled for individual, hospital and geographic factors. Data came from three sources: Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Area Health Resources Files (AHRF) and the American Hospital Association's (AHA's) annual survey database for the year of 2013. Results: COPD patients with comorbidities were less likely to be readmitted within 30 days relative to patients without comorbidities (aHR from 0.84 to 0.87, p < 0.05). In a stratified analysis, female patients with one comorbidity had a lower risk of 30-day readmission compared to female patients without comorbidity (aHR = 0.80, p < 0.05). Patients with public insurance who had comorbidities were less likely to be readmitted within 30 days in comparison with those who had no comorbidity (aHR from 0.79 to 0.84, p < 0.05). Conclusion: COPD patients with comorbidities had a lower risk of 30-day readmission compared with patients without comorbidity. Future research could use a different study design to identify the effectiveness of the HRRP.

The impact of metabolic overweight/obesity phenotypes on unplanned readmission risk in patients with COPD: a retrospective cohort study

“…In addition, the more the number of combined metabolic abnormalities, the higher the readmission rate. If metabolic abnormality was regarded as comorbidity, consistent with our view, past studies indicated that the readmission risk would raise as the number of comorbidities increased in patients with COPD who combined with comorbidities ( Roberts et al, 2011 ; Lin et al, 2020 ).…”

Evaluating the impact of chronic obstructive pulmonary disease on in‐hospital outcomes following left ventricular assist device implantation

“…Patients with COPD are known to have a higher prevalence of comorbidities that often include HF, CAD, DM, and PAD, amongst others 1 . The decreased post‐LVAD complications in COPD patients with comorbidities goes along with the finding of a recent study that shows a paradoxical lower risk of 30‐day readmission in COPD patients with comorbidities compared to COPD patients without comorbidity 33 . One of the major complications of LVAD is postoperative neurological events including both ischemic and hemorrhagic strokes 34‐37 .…”

“…1 The decreased post-LVAD complications in COPD patients with comorbidities goes along with the finding of a recent study that shows a paradoxical lower risk of 30-day readmission in COPD patients with comorbidities compared to COPD patients without comorbidity. 33 One of the major complications of LVAD is postoperative neurological events including both ischemic and hemorrhagic strokes. [34][35][36][37] COPD was associated with increased risk for stroke post-LVAD implantation in a small study of 200 patients.…”

The impact of Hospital Readmission Reduction Program on chronic obstructive pulmonary disease risk factors: a systematic review

“…Among the studies published between 2015-2020, the most widely examined risk factors included a variety of comorbidity measures such as comorbidities themselves, the number of comorbidities, comorbidity burden, and the Charlson Comorbidity Index (CCI). Specifically, nine of these articles identified comorbidities as a risk factor for increasing readmission among COPD patients (34)(35)(36)(37)(38)(39)(40)(41)(42), one found that the number of comorbidities was a risk factor for decreasing the risk of readmission (43), and another found mixed results relative to comorbidities-that is that some comorbidities such as heart disease decreased readmission risks while others like lung cancer increased readmission risks (44). Within studies examining comorbidities, four examined CCI as a risk factor, among others, to readmission.…”