The European COPD audit
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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the major reason for COPD hospitalization and increased risk for readmissions. The organizational structure of Austrian hospitals provides the opportunity to investigate the impact of specialized respiratory care compared to general care on adherence to guidelines and readmission in AECOPD.
The data from the European COPD audit, a prospective observational non-interventional cohort trial were analyzed. In total, 823 patients admitted due to AECOPD in 26 hospitals (specialized respiratory care vs. general care) within Austria were included. Patients characteristics and outcomes (length of stay, readmission rate, and mortality) were analyzed in relation to hospital resources (personnel and equipment) and adherence to international guidelines.
Patients admitted to general care had more comorbidities (Charlson comorbidity index: 2.6 ± 1.7 vs. 2.0 ± 1.4; p < 0.05) and a shorter length of stay (10.7 ± 7.8 days vs. 12.0 ± 10.2 days; p < 0.05). Patients admitted to specialized respiratory care more often underwent blood gas analysis and non-invasive ventilation (98.4% vs. 81.5% and 68.6% vs. 26.7%, p < 0.01; respectively). In multivariate analysis, the risk for AECOPD readmission was lower (odds ratio, OR 0.72 [0.51;0.91]; p < 0.05) in patients admitted to specialized respiratory care.
A greater adherence to COPD guidelines with respect to blood gas analysis and non-invasive ventilation and decreased AECOPD readmission risk was observed for patients admitted to specialized respiratory care. Adherence to guidelines may have the potential to decrease COPD readmission rates.
KeywordsCOPD Exacerbation Treatment Guidelines Hospital care
The authors wish to thank all heads responsible, local study coordinators, and senior clinicians as well as all directors of hospitals/departments for their contribution: Landesklinikum Mostviertel Amstetten, E. Friedrich, S. Nassri, Krankenhaus der Barmherzigen Brüder Eisenstadt, K. Silberbauer, N. Mitrovits, Landeskrankenhaus Hörgas, G. Wurzinger, O. Schindler, Landeskrankenhaus Universitätsklinikum Graz, H. Olschewski, C. Stöckl, Krankenhaus der Elisabethiner Graz, G. Forche, W. Auer, V Stepan, Landesklinikum Thermenregion Hochegg, P. Schenk, J. Bilek, Landeskrankenhaus Hohenems, J. Rothmund, P. Cerkl, L. Koch, Landeskrankenhaus Klagenfurt, C. Geltner, T. Jaritz, Landesklinikum Krems, P. Errhalt, M. Kössler, Landeskrankenhaus Leoben Eisenerz, M. Flicker, E. Kaufmann, Allgemeines Krankenhaus der Stadt Linz, H. Schinko, M. Riedler, E. Brehm, Krankenhaus der Elisabethinen Linz, K. Aigner, S. Zillinger, F. Wimberger, Landeskrankenhaus Natters, H. Jamnig, D. Krejci, Krankenhaus der Barmherzigen Schwestern Ried/Innkreis, F. Renner, J. Schmid, Landeskrankenhaus und Paracelsus Universität Salzburg, G. Weiss, M. Studnicka, B. Lamprecht, L. Schirnhofer, Landeskrankenhaus Steyr, J. Bolitschek, G. Schuller, Krankenhaus Vöcklabruck, B. Baumgartner, H. Stetina-Zauner, Klinikum Wels-Grieskirchen, J. Eckmayr, K. Grossruck, Wilhelminenspital, M. Kneussl, B. Heindl, Krankenhaus Hietzing, W. Pohl, D. Dörfler, I. Werner, Allgemeines Krankenhaus der Stadt Wien, L. Block, A. Kropfmüller, Hartmannspital Wien, C. Brunner, A. Fichtenberg, Otto Wagner Spital (1. und 2. Lungenabteilung), O. Burghuber, N. Vetter, I. Firlinger, E. Vesely, A. Feist, Kaiser Franz Josef Spital, M. Endler, A. Lindemeier, Krankenhaus Rudolfstiftung, E. Schenk, L. Ay.
Study concept and design: RBK, SH, MKB and OCB. Acquisition of data: RBK, SH, MS, OCB. Analysis and interpretation of data: RBK, SH, MKB, MS, DH, OCB. Drafting of the manuscript: RBK, SH. Critical revision of the manuscript for important intellectual content: MKB, DH, GF, MS, OCB. Statistical analysis: AS.
The ERS COPD audit was supported by the European Respiratory Society and the Austrian Society of Pneumology (for the Austrian data collection). The Austrian Society of Pneumology additionally supported data analysis for this work. Both societies did not intervene in drafting and critical review of the manuscript.
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Conflict of interest
R. Breyer-Kohansal, S. Hartl, M.-K. Breyer, A. Schrott, M. Studnicka, D. Neunhäuserer, G. Fülöp, and O.C. Burghuber declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethikkommission der Stadt Wien, EK 10-164-VK) and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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