Cited by 149Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesCystic Fibrosis Research Advances

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

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Alqahtani, Jaber S., Njoku, Chidiamara M., Bereznicki, Bonnie, Wimmer, Barbara C., Peterson, Gregory M., Kinsman, Leigh, Aldabayan, Yousef S., Alrajeh, Ahmed M., Aldhahir, Abdulelah M., Mandal, Swapna, Hurst, John R.·2020·European Respiratory Review

DOI 10.1183/16000617.0166-2019PMC PMC9488450

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Abstract

BACKGROUND: Readmission 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. METHODS: We 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. RESULTS: In 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)). CONCLUSIONS: Comorbidities, 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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FIGURE 1 Flow diagram of studies included in the review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Guidelines.CC BY-NC · PubMed Central

FIGURE 2 Summary of risk/predictive factors associated with 30- and 90-day all-cause hospital readmission following a hospitalised exacerbation of COPD by order of total number of studies in which there was a significant finding. ICU: intensive care unit.CC BY-NC · PubMed Central

FIGURE 3 Pooled adjusted odds ratios (ORs) for heart failure. This is a forest plot examining eight studies and risk of 30-day readmission using random effects analysis.CC BY-NC · PubMed Central

FIGURE 4 Pooled adjusted odds ratio (ORs) for renal failure. This is a forest plot examining four studies and risk of 30-day readmission using random effects analysis.CC BY-NC · PubMed Central

FIGURE 5 Pooled adjusted odds ratio (ORs) for depression. This is a forest plot examining six studies and risk of 30-day readmission using random effects analysis.CC BY-NC · PubMed Central

FIGURE 6 Pooled adjusted odds ratio (ORs) for alcohol use. This is a forest plot examining six studies and risk of 30-day readmission using random effects analysis.CC BY-NC · PubMed Central

FIGURE 7 Pooled adjusted odds ratio (ORs) for female sex. This is a forest plot examining nine studies and risk of 30-day readmission using random effects analysis.CC BY-NC · PubMed Central

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Background
Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study
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“Comorbid conditions also have strong associations with readmission in other conditions requiring hospitalization, including influenza, congestive heart failure, and chronic obstructive pulmonary disease.(14,24,25) Our analysis is broadly consistent with findings from other reports that underlying pulmonary and cardiac…”
Result
Review of Prediction Analytics Studies on Readmission for the Chronic Conditions of CHF and COPD: Utilizing the PRISMA Method
Ben‐Assuli, O. (2021) · Information Systems Management · doi:10.1080/10580530.2021.1928341 · Cited by 8
“Typically, only one diagnosis is considered in review articles (e.g., heart failure (Mahajan et al., 2018), kidney injury (Zhao & Chen, 2020), liver resection (Zhao et al., 2017) and COPD (Alqahtani et al., 2020)).”
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The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients
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Characteristics of 12-Month Readmission for Hospitalized Patients with COPD: A Propensity Score Matched Analysis of Prospective Multicenter Study
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“Furthermore, studies mostly focused on short-term readmission such as 30 days or 90 days after discharge.(11,12) Several studies have explored rates and risk factors related to readmission within 12 months, most were retrospective studies.”
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COPD and Depression Analysis in Regard to Obstructive Pulmonary Levels
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30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital
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“…findings showed a higher baseline mMRC grading is statistically associated with 30-day readmission, but it was not significant in Alqahtani et al. 22 The reason behind was Alqahtani et al looked at the patients’ mMRC grading on admission and before discharge, which usually will be higher as…”
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New insights into the pathophysiology and epidemiology of COPD exacerbations
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The Role of Early Warning Scoring Systems NEWS and MEWS in the Acute Exacerbation of COPD
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“A systematic review and meta-analysis investigating the all-cause hospital readmission following hospitalization for exacerbation AECOPD identified co-morbidities, previous exacerbations and increased length of stay as major risk factors for both 30- and 90-day all-cause readmission.(43) In a recent study on prognosti…”
Background
Translation, cross-cultural adaptation, reliability, and construct validity of the Brazilian Portuguese version of the Basic Psychological Needs in Exercise Scale
Karloh, M., Gavenda, S. G., de Araujo, J. E., Alexandre, H. F., Silva, I. J. C. S., Gulart, A. A., Munari, A. B., Vlachopoulos, S. P., Matias, T. S., & Mayer, A. F. (2023) · Chronic Respiratory Disease · doi:10.1177/14799731231183445 · Cited by 7
“15,46 Besides, the BPNES scores in each assessment con ﬁ rm the agreement and stability of the measurements.”
Background
Prediction of Acute COPD Exacerbation in the Swiss Multicenter COPD Cohort Study (TOPDOCS) by Clinical Parameters, Medication Use, and Immunological Biomarkers
Huebner, S. T., Henny, S., Giezendanner, S., Brack, T., Brutsche, M. H., Chhajed, P. N., Clarenbach, C. F., Dieterle, T., Egli, A., Frey, M., et al. (2021) · Respiration · doi:10.1159/000520196 · Cited by 7
Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway
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“Previous analyses of readmissions [13, 17, 30, 31] have lacked the inclusion of variables related to out-patient healthcare use.”
Developing and validating prediction models for severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) in China: a prospective observational study
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Interventions to standardise hospital care at presentation, admission or discharge or to reduce unnecessary admissions or readmissions for patients with acute exacerbation of chronic obstructive pulmonary disease: a scoping review
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Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease
Yılmaz, C., Özkan, S., & Erer, O. F. (2021) · Tuberkuloz ve Toraks · doi:10.5578/tt.20219705 · Cited by 6
“Some studies have also found patients with the shortest LOS were at higher risk than those who stayed slightly longer (6,14).”
Influential
Taking Charge After Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Feasibility Trial of a Psychologically Informed Self-Management Intervention
Levack, W., Weatherall, M., McNaughton, H., McNaughton, A., Hobman, A., Jones, B. H., Ingham, T. R., & Fingleton, J. (2023) · International Journal of COPD · doi:10.2147/copd.s393644 · Cited by 6
Mortality and readmission risk for hospitalised patients with acute exacerbation of COPD with and without spirometric obstruction: a longitudinal observational study in China
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Sleep Apnea, Obesity, and Readmissions: Real Risks or Residual Confounding?
Donovan, L. M., & Au, D. H. (2022) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202111-1304ed · Cited by 6
30-day Readmission After an Acute Exacerbation of Chronic Obstructive Pulmonary Disease is Associated with Cardiovascular Comorbidity
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Healthcare consumers' and professionals' perceived acceptability of evidence‐based interventions for rural transitional care
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The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data-Based Social Network Study
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Nursing diagnoses and hospital readmission of patients with respiratory diseases: Findings from a case–control study
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“(Alqahtani et al., 2020; Press et al., 2021; Ruan et al., 2023).”
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A MEMS seismometer respiratory monitor for work of breathing assessment and adventitious lung sounds detection via deep learning
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“2 Furthermore, although patients play a key role in communicating warning signs to healthcare professionals, older patients tend to have atypical illness presentations, which may manifest as reduced cognition 26 and undermine their ability to do so independently.”
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Hospital Readmission Due to Chronic Obstructive Pulmonary Disease: A Longitudinal Study
Njoku, C. M., Wimmer, B. C., Peterson, G. M., Kinsman, L., & Bereznicki, B. J. (2022) · International Journal of Health Policy and Management · doi:10.34172/ijhpm.2022.5770 · Cited by 4
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Authors: Alqahtani, J. S., Njoku, C. M., Bereznicki, B., Wimmer, B. C., Peterson, G. M., Kinsman, L., Aldabayan, Y. S., Alrajeh, A. M., Aldhahir, A. M., Mandal, S., & Hurst, J. R.
Affiliations: Prince Sultan Military College of Health Sciences (SA)
University of Tasmania (AU)
University of Newcastle Australia (AU)
University College London (GB)
Royal Free London NHS Foundation Trust (GB)
Corresponding author: Alqahtani, Jaber S.
ORCID: Alqahtani, Jaber S.
Njoku, Chidiamara M.
Bereznicki, Bonnie
Wimmer, Barbara C.
Peterson, Gregory M.
Kinsman, Leigh
Aldabayan, Yousef S.
Alrajeh, Ahmed M.
Aldhahir, Abdulelah M.
Mandal, Swapna
Hurst, John R.
Venue: European Respiratory Review
Publisher: European Respiratory Society (ERS)
Published: 2020-06-03
Volume: 29
Issue: 156
Pages: 190166
ISSN: 0905-9180 (ISSN-L)
1600-0617
DOI: 10.1183/16000617.0166-2019
PMC: PMC9488450
OpenAlex: W3033975634
Cited by: 149
References: 57
Citations by year: 2026: 19 · 2025: 19 · 2024: 16 · 2023: 34 · 2022: 26 · 2021: 28 · 2020: 7
FWCI: 3.33
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
Locations: European Respiratory Review (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
UTAS Research Repository (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
UCL Discovery (University College London) (submittedVersion)
Figshare (submittedVersion, cc-by-nc)
NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
Keywords: COPD exacerbations, hospital readmission, all-cause readmission, risk factors, comorbidities, heart failure, renal failure, depression, alcohol consumption, length of hospital stay, sex differences
MeSH terms: Adult, Aged, Aged, 80 and over, Female, Humans, Length of Stay, Male, Middle Aged, Patient Readmission, Prognosis, Risk Factors, Time Factors, Comorbidity, Disease Progression, Risk Assessment, Pulmonary Disease, Chronic Obstructive

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

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