Impact of clinical factors on hospital stay and hospital readmission rate after acute exacerbation of COPD: a retrospective cross-sectional study

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a condition with high morbidity and cost to health services due to a high number of exacerbations necessitating multiple and prolonged hospitalizations. The length of hospital stays and hospital readmission rate is related to patient age, sex, disease severity, current smoking status, comorbidities, dyspnea grade, carbon dioxide partial pressures, use of mechanical ventilation, previous exacerbation, long-term oxygen therapy, and inpatient diuretics use. The purpose of the study was to identify the differential effects of patient and treatment-related factors on the length of hospital stay and hospital readmission for COPD exacerbation-related admissions. Methods: A hospital-based retrospective cross-sectional study was conducted among 151 patients with acute exacerbation of COPD admitted at Civil Service Hospital, Kathmandu from August 2021 to March 2022. Ethical approval was taken from the Institutional Review Committee, Civil Service Hospital (Reference no. 18/ 2022). A convenience sampling method was followed. Data regarding different clinical factors were collected in a semi-structured questionnaire. The data were entered and analyzed through Microsoft Excel 365 and SPSS version 22.0 using a binary regression model. Results: Comorbidities, current smoking, dyspnea grade mMRC IV, mechanical ventilation, and long-term oxygen therapy were significantly associated with prolonged hospital stays for COPD exacerbation-related admissions. The corresponding odd ratio is (OR 3.4, 95% CI: 1.24–9.29); (OR 21.4, 95% CI: 6.17–74.57); (OR 2.5, 95% CI: 1.20–5.45); (OR 5.6, 95% CI: 1.20–26.35); (OR 2.4, 95% CI: 1.02–5.90), respectively. Conclusions: The effect of clinical factors such as comorbidities status, current smoking habits, higher grade of mMRC dyspnea scale, mechanical ventilation, and long-term oxygen therapy needed to be considered to optimize care for COPD patients needing hospital admissions and hence decrement in hospital costs.