Abstract
Introduction: Medicare patients experience a high-rate of returning to the hospital within 30 days of discharge. Rates of 30-day readmissions after discharge for pneumonia average 20%. Obesity and COPD diagnosis are associated with pulmonary complications, but their relationship to readmissions within 30 days after pneumonia discharge is yet to be elucidated.
Aims and Hypothesis: To determine if high BMI and a history of COPD are associated with 30-day hospital return rates after initial pneumonia discharge diagnosis. We hypothesized that 1) Obese patients would experience higher 30-day hospital return rates than patients with BMI classified as underweight, normal, or overweight; 2) Patients with a COPD diagnosis would experience higher 30-day hospital return rates than those without.
Methods: This is a secondary analysis of an existing database created during the implementation of the care transitions program for hospitalized patients age ³ 75 admitted to a community teaching hospital from July 2015 to June 2017 after initial pneumonia discharge diagnosis. Direct admissions to the ICU and discharges to hospice were excluded. BMI was categorized as underweight, normal, overweight, and obese (<18.5, 18.6 - 24.9, 25 - 29.9, >30). The 30-day hospital return rate (hospitalizations, observation stays and ED visits without admission) were included. Data were analyzed using a chi-squared test with a p value of <0.05 for significance.
Results: Of the eligible 24,766 patients, 603 (2.4%) were discharged with a pneumonia diagnosis, and of these 23% (n=138) returned to the hospital within 30 days. There was no significant difference in hospital return rates between patients underweight, normal, overweight, or obese (18%, 24%, 23%, 21%, p = 0.08). There was also no significant difference in hospital return rates between patients with/without a COPD diagnosis in the underweight, normal, overweight, or obese groups.
Conclusion: Although elevated BMI and COPD diagnosis are generally associated with a higher rate of pulmonary complications, we did not find a significant difference in terms of patient return to hospital with respect to patient BMI or COPD diagnosis in the population we studied. This lack of association could be due to the relatively small sample size of some of our categories, or the effects of other comorbidities in these patient groups. Further studies should continue to elucidate the association between BMI, COPD, and return to hospital from pneumonia diagnosis with a larger sample size of older adults.
