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Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis
Open accessAbstract
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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“the 90-day readmission rate estimated for the UAE (35.9%) falls in the upper range of the published readmission rates [16,23].”
From Chronic Obstructive Pulmonary Disease in the Gulf Cooperation Council: Acute-Care Utilization and Medication Adherence: A PRISMA-ScR Scoping Review (2026) · cites this paper as [23]
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“These findings are consistent with the international COPD literature demonstrating that multimorbidity and greater disease severity are associated with an increased risk of hospital readmission following COPD exacerbation [23].”
From Chronic Obstructive Pulmonary Disease in the Gulf Cooperation Council: Acute-Care Utilization and Medication Adherence: A PRISMA-ScR Scoping Review (2026) · cites this paper as [23]
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“In other studies, the rate of 30-day readmissions was between 8.8% and 26.0%, whereas the rate of 90-day readmissions was between 17.5% and 39.0% [23].”
From Chronic Obstructive Pulmonary Disease in the Gulf Cooperation Council: Acute-Care Utilization and Medication Adherence: A PRISMA-ScR Scoping Review (2026) · cites this paper as [23]
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Metadata
- 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
- 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
- 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
- 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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