Johannesdottir S, Christiansen C, Johansen M, Olsen M, Xiao X, Parker J, Molfino N, Lash T, Fryzek J. 2013. Hospitalization with acute exacerbation of chronic obstructive pulmonary disease and associated health resource utilization: A population-based Danish cohort study. J Med Econ 16(7),DOI: 10.3111/13696998.2013.800525.
Objective: Health resource utilization (HRU) and outcomes associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are not well described. We therefore conducted a population-based cohort study to characterize patients hospitalized with AECOPD with regard to HRU, mortality, recurrence, and predictors of readmission with AECOPD. Methods: Using Danish healthcare databases, we identified COPD patients with at least one AECOPD hospitalization between 2005 and 2009 in Northern Denmark. We characterized hospitalized AECOPD patients’ HRU, in-hospital mortality, 30-day, 60-day, 90-day, and 180-day post-discharge mortality and recurrence risk, and predictors of readmission with AECOPD in the year following study inclusion.
Results: We observed 6,612 AECOPD hospitalizations among 3,176 prevalent COPD patients. Among all AECOPD hospitalizations, median length of stay was 6 days (interquartile range [IQR] 3-9 days); 5 days (IQR 3-9) among those without ICU stay and 11 days (IQR 7-20) among the 8.6% admitted to the ICU. Mechanical ventilation was provided to 193 (2.9%) and non-invasive ventilation to 479 (7.2%) admitted patients. In-hospital mortality was 5.6%. Post-discharge mortality was 4.2%, 7.8%, 10.5%, and 17.4% at 30, 60, 90, and 180 days, respectively. Mortality and readmission risk increased with each AECOPD hospitalization experienced in the first year of follow-up. Readmission at least twice in the first year of follow-up was observed among 286 (9.0%) COPD patients and was related to increasing age, male gender, obesity, asthma, osteoporosis, depression, myocardial infarction, diabetes I and II, any malignancy, and hospitalization with AECOPD or COPD in the prior year.
Limitations: The study included only hospitalized AECOPD patients among prevalent COPD patients. Furthermore, we lacked information on clinical variables.
Conclusion: These findings indicate that AECOPD hospitalizations are associated with substantial mortality and risk of recurrence.