Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD.

Aim

To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation.

Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies.

Results

Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8–44.8% at 31–90 days, 17.9–63.0% at 6 months, and 25.0–87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs.

Conclusions

Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.

中文翻译：

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COPD患者再次入院的危险因素和相关结果：系统评价

背景

慢性阻塞性肺疾病（COPD）是计划外再次入院的主要原因。需要确定COPD患者再入院的危险因素和预防策略。

目标

为了系统地回顾和总结因COPD加重而再次住院的患病率，危险因素和结局。

方法

遵循系统评价和荟萃分析的首选报告项目指南。搜索了五个数据库以进行相关研究。

结果

来自30个国家/地区的57项研究符合纳入标准。出院后30天，COPD相关再入院率从2.6到82.2％不等，在31-90天时为11.8-44.8％，在6个月时为17.9-63.0％，在出院后12个月时为25.0-87.0％。报告的与再入院相关的因素存在差异，这可能反映了当地情况的变化，例如提供社区服务来护理COPD恶化。指数入院前一年的住院治疗是COPD相关再入院的关键预测指标。合并症（特别是哮喘病），生活在贫困地区，住在疗养院或出院到护理院也与再入院有关。相对于那些没有再次入院的人，重新入院的患者院内死亡率更高，长期生存期更短，

结论

前一年住院是COPD相关再入院的主要危险因素。患病率和与COPD相关的再入院相关的报道因素的差异表明，危险因素不能一概而论，应根据当地医疗环境调整干预措施。