Role of Comorbidities in Treatment and Outcomes after Chronic Obstructive Pulmonary Disease Exacerbations

Spece, Laura J; Epler, Eric; Donovan, Lucas M.; Griffith, Matthew; Collins, Margaret P.; Feemster, Laura C.; Au, David H.

doi:10.1513/annalsats.201804-255oc

Cited by 33 publications

(20 citation statements)

References 40 publications

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“…Many other comorbidities were also reported (tables S2 and S3). Four studies [22,38,43,47] used the comorbidity index to assess comorbidities. SPECE et al [47] found that each one-point increase in comorbidity index was associated with a 24% increased risk of readmission or death: OR 1.24 (95% CI 1.18-1.30).…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

et al. 2020

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BackgroundReadmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.MethodsWe systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.ResultsIn total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22–1.37)), renal failure (1.26 (1.19–1.33)), depression (1.19 (1.05–1.34)) and alcohol use (1.11 (1.07–1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88–0.94)).ConclusionsComorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.

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Section: Meta-analysis Resultsmentioning

confidence: 99%

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

et al. 2020

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“…The baseline subjects seemed to have higher comorbidity scores, whereas the postbundle subjects had lower percent of predicted FEV 1 , both of which increase the risk of ED revisit. 35,36 Lastly, the revisit rates are assessed by individual encounters rather than by individual subjects. Frequent ED utilization is common among individual subjects with COPD, and some subjects had more than one encounter in our system throughout the study period.…”

Section: Discussionmentioning

confidence: 99%

COPD Care Bundle in Emergency Department Observation Unit Reduces Emergency Department Revisits

et al. 2019

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BACKGROUND: COPD exacerbations lead to accelerated decline in lung function, poor quality of life, and increased mortality and cost. Emergency department (ED) observation units provide short-term care to reduce hospitalizations and cost. Strategies to improve outcomes in ED observation units following COPD exacerbations are needed. We sought to reduce 30-d ED revisits for COPD exacerbations managed in ED observation units through implementation of a COPD care bundle. The study setting was an 800-bed, academic, safety-net hospital with 700 annual ED encounters for COPD exacerbations. Among those discharged from ED observation unit, the 30-d all-cause ED revisit rate (ie, the outcome measure) was 49% (baseline period: August 2014 through September 2016). METHODS: All patients admitted to the ED observation unit with COPD exacerbations were included. A multidisciplinary team implemented the COPD bundle using iterative plan-do-study-act cycles with a goal adherence of 90% (process measure). The bundle, adopted from our inpatient program, was developed using care-delivery failures and unmet subject needs. It included 5 components: appropriate inhaler regimen, 30-d inhaler supply, education on devices available after discharge, standardized discharge instructions, and a scheduled 15-d appointment. We used statistical process-control charts for process and outcome measures. To compare subject characteristics and process features, we sampled consecutive patients from the baseline (n 5 50) and postbundle (n 5 83) period over 5-month and 7-month intervals, respectively. Comparisons were made using t tests and chi-square tests with P < .05 significance. RESULTS: During baseline and postbundle periods, 410 and 165 subjects were admitted to the ED observation unit, respectively. After iterative plan-do-study-act cycles, bundle adherence reached 90% in 6 months, and the 30-d ED revisit rate declined from 49% to 30% (P 5 .003) with a system shift on statistical process-control charts. There was no difference in hospitalization rate from ED observation unit (45% vs 51%, P 5 .16). Subject characteristics were similar in the baseline and postbundle periods. CONCLUSIONS: Reliable adherence to a COPD care bundle reduced 30-d ED revisits among those treated in the ED observation unit.

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“…COPD is a disease associated with many co-morbidities and also with high mortality. [6] Advanced COPD is associated with weight loss. [7] Malnourished patients of COPD have increased risk of in-hospital deaths and of readmission.…”

Section: Discussionmentioning

confidence: 99%

Variation in body mass index in patients with chronic obstructive pulmonary disease

Paudel

Mandal

Kafle

et al. 2019

J Family Med Prim Care

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Introduction: Chronic obstructive pulmonary disease (COPD) is associated with systemic inflammation. Weight loss seen in patients with COPD is a consequence of this inflammation. We hypothesized that higher grades of COPD are associated with greater degree of weight loss. Materials and Methods: In this cross-sectional study, we assessed the body mass index (BMI) of 34 patients with COPD proven by handheld spirometer. The difference in BMI among various grades of COPD was compared. Results: BMI was found to be inversely related to the grades of COPD in our study ( P = 0.001). No significant difference was seen among the patients with regards to age and duration of symptoms before presentation. Conclusion: Advanced COPD is associated with greater degree of weight loss.

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Role of Comorbidities in Treatment and Outcomes after Chronic Obstructive Pulmonary Disease Exacerbations

Abstract: Comorbidity was associated with 30-day readmission and mortality, and with delivery of fewer treatments known to be beneficial among patients with COPD exacerbation.

Cited by 33 publications

References 40 publications

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

COPD Care Bundle in Emergency Department Observation Unit Reduces Emergency Department Revisits

Variation in body mass index in patients with chronic obstructive pulmonary disease

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