Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease

• Published in: American journal of respiratory and critical care medicine 2018-04, Vol.197 (8), p.1009-1017
• Main Authors: Lindenauer, Peter K, Dharmarajan, Kumar, Qin, Li, Lin, Zhenqiu, Gershon, Andrea S, Krumholz, Harlan M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Chronic obstructive pulmonary disease; Cohort Studies; Female; Hospitalization - statistics & numerical data; Humans; Logistic Models; Male; Medicare; Medicare - statistics & numerical data; Mortality; Original; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Risk Assessment - statistics & numerical data; Time Factors; United States; Ventilators
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201709-1852OC

Characterization of the dynamic nature of posthospital risk in chronic obstructive pulmonary disease (COPD) is needed to provide counseling and plan clinical services. To analyze risk of readmission and death after discharge for COPD among Medicare beneficiaries aged 65 years and older and to determine the association between ventilator support and risk trajectory. We computed daily absolute risks of hospital readmission and death for 1 year after discharge for COPD, stratified by ventilator support. We determined the time required for risks to decline by 50% from maximum daily values after discharge and for daily risks to plateau. We compared risks with those found in the general elderly population. Among 2,340,637 hospitalizations, the readmission rate at 1 year was 64.2%, including 63.5%, 66.0%, and 64.1% among those receiving invasive, noninvasive, and no ventilation, respectively. Among 1,283,069 hospitalizations, mortality at 1 year was 26.2%, including 45.7%, 41.8%, and 24.4% among those same respective groups. Daily risk of readmission declined by 50% within 28, 39, and 43 days and plateaued at 46, 54, and 61 days among those receiving invasive, noninvasive, and no ventilation, respectively. Risk of death declined by 50% by 3, 4, and 17 days and plateaued by 21, 18, and 24 days in the same respective groups. Risks of hospitalization and death were significantly higher after discharge for COPD than among the general Medicare population. Discharge from the hospital is associated with prolonged risks of readmission and death that vary with need for ventilator support. Interventions limited to the first month after discharge may be insufficient to improve longitudinal outcomes.