Clinical factors contributing readmission in 28 days due to acute exacerbation in COPD patients in Maharat Nakhon Ratchasima Hospital

Abstract

Chronic obstructive pulmonary disease, COPD) can be occasionally complicated by acute exacerbation generally leading to increased morbidity and mortality. This research was aimed to describe the clinical characteristics of the COPD patients, the treatment outcomes and the clinical factors contributing the acute exacerbation resulting in readmission within 28 days. This study was retrospective descriptive, recruiting the COPD patients who were readmitted within 28 days due to acute exacerbation since 1 Oct 2013 - 30 Jun 2015 in Maharat Nakhon Ratchasima Hospital. There were 83 patients who fulfilled the inclusion criteria, mean age 72.7 years, 77 males and 6 females. For smoking, 40 were ex-smokers whereas 31 (37.3 %) were current smokers. The following parameters were in two groups, the first admission and the readmission groups, respectively. Oxygen mask with bag was offered in 44.6 % and 36.1 %, respiratory support with ventilator in 55.4 % and 63.9 %, corticosteroid injection in 97.6 % and 91.6 %, bronchodilator aerosol in 100 % and 98.8 %, antibiotics administration in 92.8 % and 89.2 %, respectively. The most common contributing factors for acute exacerbation was pneumonia in 51.8 % and 71.1 % and the most common causative organism was Ps. aeruginosa (20.9 %) and A. baumannii (30.5 %). The hospital stay day was averagely 4.4 days and 7.2 days. The expense was 17,910 Baht and 36,239 Baht in the first admission and in readmission groups, respectively. Thirty patients in the readmission group were dead (36.1 %). In conclusion, pneumonia was the important contributing factor for acute exacerbation leading to readmission within 28 days resulting in increased morbidity and mortality in COPD patients.