Abstract
Introduction and objectivesReadmission rates following hospitalization for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective is 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 four electronic databases: MEDLINE, Embase, CINAHL and Scopus from inception date to June 10, 2019. We included quantitative studies that investigated all-cause COPD readmissions and analysed the contribution of risk factors or predictors associated with readmission. Two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extracted data. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized 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. Thirty-two studies met the inclusion criteria, and 14 studies were included in the meta-analysis. Among the 32 studies, three were rated as ‘fair’ in the quality assessment. The remaining papers were ranked as ‘good’ quality. The readmission rate ranged from 8.8% to 26.0% at 30 days and from 17.5% to 39.0% at 90 days. Our narrative analysis showed that comorbidities, previous exacerbations and hospitalizations, and increased length of initial hospital stay were major risk factors for readmission at 30 and 90 days (see table 1). Pooled adjusted ORs (95% CIs) 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 independently associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor 0.91 (0.88–0.93).ConclusionsIn this systematic review and meta-analysis of 32 studies including more than 3.5 million patients with COPD, comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for all-cause readmission at 30 and 90 days. Holistic interventions with careful attention to the optimal management of comorbidities are likely to be the most successful strategies to reduce the risk of readmission.Abstract S118 Table 1