Predictors of 3-Month Rehospitalization After Acute Exacerbation of Chronic Obstructive Lung Disease

Abstract

SESSION TITLE: COPD Epidemiology & Physiology PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: To identify predictors associated with hospital readmission in patients discharged after acute exacerbation of chronic obstructive lung disease (AECOPD). METHODS: A retrospective study was conducted in a Malaysian tertiary hospital. All patients discharged from hospital with the primary diagnosis of AECOPD between 1stJanuary 2007 till 31st December 2011 was included in the study. Manual reviews of medical (admission) records were used to extract data from patient's files. RESULTS: A total of 259 patients were included in the analysis. The median age was 70 (IQR=59.7-76.7). Majority of patients were Chinese (47.9%), followed by Malay (33.2%) and Indian (18.1%). The most common comorbidities identified were hypertension (29%), pneumonia (26.6%), and diabetes mellitus (15.8%). The readmission rate within 3 months was 21%. Univariate analysis showed living alone (p=0.007), hypertension (p=0.011), use of intravenous salbutamol during admission (p=0.048), intake of short acting beta blockers (SABB) alone (p=0.018) and combination of anticholinergic agents plus beta blocker (p= 0.037) before index admission were associated with higher rehospitalization. Multivariate analysis confirmed that pre-admission SABB (OR, 2.871; 95% CI, 1.463 -5.635) and anticholinergic plus beta blocker combination (OR, 2.205; 95% CI, 1.142 - 4.256) use as the predictors for hospital readmission within 3 months. However, hypertension (OR, 0.336; 95% CI, 0.144 - 0.783) and intravenous salbutamol use (OR, 0.175; 95% CI, 0.038 - 0.803) were identified as the protector for rehospitalization. CONCLUSIONS: Hospital readmission among patients admitted with AECOPD was relatively high in local setting. The use of certain medications was found to significantly contribute for hospital readmission. Close monitoring with periodic medication review can help in controlling the symptoms and reducing hospital readmission among COPD patients. CLINICAL IMPLICATIONS: Medications treatment during and after hospitalisation are important factors that affect short term rehospitalisation among patients with AECOPD. Identification of patients at higher risk for hospital readmission based on individual factors may help in planning for follow-up period and closer monitoring. DISCLOSURE: The following authors have nothing to disclose: Sana' AL Aqqad, Teo Ley Khim, Irfhan Ali Hyder Ali, Balamurugan TangiisuranNo Product/Research Disclosure Information.