Depression is Associated with Readmission Due To Acute Exacerbation Of Chronic Obstructive Pulmonary Disease.
Ann Am Thorac Soc. 2015 Nov 24;
Authors: Iyer AS, Bhatt SP, Garner JJ, Wells JM, Trevor JL, Patel NM, Kirkpatrick D, Williams JC, Dransfield MT
Rationale Hospitalization for acute exacerbation of COPD (AECOPD) is associated with significant morbidity and health care costs, and US hospitals are now penalized by the Centers for Medicare and Medicaid for excessive readmissions. Identifying patients at risk for readmission is important, but modifiable risk factors have not been clearly established and the potential contributing role of psychological disease has not been adequately examined. We hypothesized that depression and anxiety would increase the risk for both short- and long-term readmissions due to acute exacerbation of COPD. Objectives To characterize the associations between depression and anxiety and COPD readmission risk. Methods We examined medical records for all patients admitted to the University of Alabama at Birmingham Hospital with a primary diagnosis of acute exacerbation of COPD by ICD-9 codes between November 2010 and October 2012. Those who did not meet standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as primary diagnosis were excluded. Comorbidities were recorded based on physician documentation of the diagnosis and/or the use of medications in the electronic medical record Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at one year and within 30 and 90 days. Measurements and Main Results 422 patients were included with 132 readmitted in one year. Mean age was 64.8±11.7 years, and mean percent predicted FEV1 was 48.1±18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV1 (44.9±17.3% vs 50.2±19.4%; P = 0.05) and higher frequency of depression (47.7% vs 23.4%; P < 0.001). On multivariable analysis, one-year readmission was independently associated with depression (adjusted OR 2.67; 95% CI 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR 0.34; 95% CI 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR 3.83; 95% CI 1.84 - 7.96) and 90 days (adjusted OR 2.47; 95% CI 1.34 - 4.55). Conclusions Depression is an independent risk factor for both short- and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced one-year readmission.
PMID: 26599286 [PubMed - as supplied by publisher]