Early hospital readmission increases short and long – term mortality in patients with interstitial lung disease

Main Article Content

Diego Castillo
Silvia Barril
Ana Rodrigo-Troyano
Paloma Millan-Billi
Guillermo Suarez-Cuartin
Ana Alonso
Tomas Franquet
Laura Lopez-Vilaro
Ivan Castellvi
Vicente Plaza
Oriol Sibila

Keywords

Interstitial lung disease, Hospitalization, Mortality, Readmission

Abstract

Objective: To investigate the prognostic impact of early readmission (30 days) in hospitalized patients with Interstitial Lung Disease (ILD).


Methods: Observational study analysing a cohort of patients hospitalized in a respiratory ward at a Universitary Hospital. Demographic, clinical data and survival status were collected from patients records. Early readmission was defined as hospitalization within 30 days after patients discharge. The primary outcome was 90-day and 1-year all-cause mortality.


Results: Between 2013 to 2016, a total of 2.238 patients were admitted in the respiratory ward and 98 (4,4%) had a diagnosis of ILD. Among them, 74 patients were discharged (25% in-hospital mortality). Early readmission was observed in 15 cases (20.2%). Early readmitted patients were more frequently current smokers (20% vs. 2%, p=0.02). After a multivariate analysis, early readmission was found to be independently associated with 90-day and 1 year mortality (Odds Ratio (OR) 17.6, 95% Confidence Interval (CI) 4.5-69-2, p=0.001 and OR 4.5; 95CI 1.3-15.2, p=0.01, respectively).


Conclusion: In patients with ILD, early readmission after hospitalization increases both short-term and long term mortality. Thus, preventing early readmission after discharge from hospital admission may have an impact in the clinical course of ILD patients. Further studies are required to identify factors contributing to early readmission.

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References

1. Bradley B, Branley HM, Egan JJ, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax. 2008;63 Suppl 5:v1-58.
2. Kolb M, Vasakova M. The natural history of progressive fibrosing interstitial lung diseases. Respiratory research. 2019;20(1):57.
3. Adegunsoye A, Oldham JM, Chung JH, et al. Phenotypic Clusters Predict Outcomes in a Longitudinal Interstitial Lung Disease Cohort. Chest. 2017.
4. Moua T, Westerly BD, Dulohery MM, Daniels CE, Ryu JH, Lim KG. Patients With Fibrotic Interstitial Lung Disease Hospitalized for Acute Respiratory Worsening: A Large Cohort Analysis. Chest. 2016;149(5):1205-1214.
5. Brown AW, Fischer CP, Shlobin OA, et al. Outcomes after hospitalization in idiopathic pulmonary fibrosis: a cohort study. Chest. 2015;147(1):173-179.
6. Mullerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999-1007.
7. Roberts MH, Clerisme-Beaty E, Kozma CM, Paris A, Slaton T, Mapel DW. A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC pulmonary medicine. 2016;16(1):68.
8. Guerrero M, Crisafulli E, Liapikou A, et al. Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study. PloS one. 2016;11(3):e0150737.
9. Shah T, Press VG, Huisingh-Scheetz M, White SR. COPD Readmissions: Addressing COPD in the Era of Value-based Health Care. Chest. 2016;150(4):916-926.
10. International Statistical Classification of Diseases and Related Health Problems 10th Revision. https://icd.who.int/browse10/2019/en#/J80-J84.
11. Xaubet A. Diagnóstico y tratamiento de las enfermedades pulmonares intersticiales difusas Archivos de bronconeumologia. 2003;39:580-600.
12. Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. American journal of respiratory and critical care medicine. 2013;188(6):733-748.
13. Quality AfHRa. Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. . https://www.ahrq.gov/downloads/pub/ahrqqi/pqiguide.pdf.
14. Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60(11):925-931.
15. Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest. 2015;147(5):1219-1226.
16. Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA Intern Med. 2016;176(4):484-493.
17. Kristensen SR, Bech M, Quentin W. A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States. Health Policy. 2015;119(3):264-273.
18. Collard HR, Ryerson CJ, Corte TJ, et al. Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report. American journal of respiratory and critical care medicine. 2016;194(3):265-275.
19. Spagnolo P, Wuyts W. Acute exacerbations of interstitial lung disease: lessons from idiopathic pulmonary fibrosis. Curr Opin Pulm Med. 2017;23(5):411-417.
20. Durheim MT, Judy J, Bender S, et al. In-Hospital Mortality in Patients with Idiopathic Pulmonary Fibrosis: A US Cohort Study. Lung. 2019;197(6):699-707.
21. Pedraza-Serrano F, Jimenez-Garcia R, Lopez-de-Andres A, et al. Characteristics and outcomes of patients hospitalized with interstitial lung diseases in Spain, 2014 to 2015. Medicine (Baltimore). 2019;98(21):e15779.
22. Yamazaki R, Nishiyama O, Saeki S, Sano H, Iwanaga T, Tohda Y. Characteristics of patients with chronic idiopathic interstitial pneumonia undergoing repeated respiratory-related hospitalizations: A retrospective cohort study. PloS one. 2020;15(4):e0232212.
23. Stallings-Smith SH, H.Y.; Peterson, B.N.; Apatu, E.J.I.; Spaulding, A.C. Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease. Am J Prev Med. 2019;57(5).