Hospital readmissions for COPD: a retrospective longitudinal study

Prevention of COPD hospital readmissions is an international priority aimed to slow disease progression and limit costs. Evidence of the risk of readmission and of interventions that might prevent it is lacking. We aimed to determine readmission risk for COPD, factors influencing that risk, and variation in readmission risk between hospitals across 7.5 million people in London. This retrospective longitudinal observational study included all COPD admissions to any hospital in the United Kingdom among patients registered at London general practices who had emergency NHS COPD hospital admissions between April 2006 and March 2010. Influence of patient characteristics, geographical deprivation score, length of stay, day of week of admission or of discharge, and admitting hospital, were assessed using multiple logistic regression. 38,894 COPD admissions of 20,932 patients aged ≥45 years registered with London general practices were recorded. 6,295 patients (32.2%) had at least one COPD readmission within 1 year. 1,993 patients (10.2%) were readmitted within 30 days and 3,471 patients (17.8%) were readmitted within 90 days. Age and patient geographical deprivation score were very weak predictors of readmission. Rates of COPD readmissions within 30 days and within 90 days did not vary among the majority of hospitals. The relatively low COPD readmission rates and lack of variation between hospitals calls into question the value of COPD readmission rate as a marker of quality of care. Absence of a clear opportunity to significantly reduce readmission risk emphasises the need to direct efforts towards smoking cessation in primary and secondary prevention of COPD.