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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, JS, Njoku, CM, Bereznicki, B ORCID: 0000-0001-8463-4817, Wimmer, BC ORCID: 0000-0003-3166-7126, Peterson, GM ORCID: 0000-0002-6764-3882, Kinsman, L ORCID: 0000-0002-0790-5887, Aldabayan, YS, Alrajeh, AM, Aldhahir, AM, Mandal, S and Hurst, JR 2020 , 'Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis' , European Respiratory Review, vol. 29, no. 156 , pp. 1-16 , doi: 10.1183/16000617.0166-2019.

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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 thefactors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbationof COPD.Methods: We systematically searched electronic databases from inception to 5 November 2019. Data wereextracted by two independent authors in accordance with the Preferred Reporting Items for SystematicReviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version ofthe Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a metaanalysis 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 32papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rateranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed thatcomorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital staywere 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 riskof 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 weresignificant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with anexacerbation of COPD.

Item Type: Article
Authors/Creators:Alqahtani, JS and Njoku, CM and Bereznicki, B and Wimmer, BC and Peterson, GM and Kinsman, L and Aldabayan, YS and Alrajeh, AM and Aldhahir, AM and Mandal, S and Hurst, JR
Keywords: chronic obstructive pulmonary disease, risk factors, hospital readmission, COPD, exacerbation
Journal or Publication Title: European Respiratory Review
Publisher: European Respiratory Society
ISSN: 0905-9180
DOI / ID Number: 10.1183/16000617.0166-2019
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Copyright 2020 ERS. Licensed under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

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