Clinical question: Does the initiation of pulmonary rehabilitation after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation impact rehospitalizations?
Background: COPD exacerbations account for about half of annual health care costs for COPD in general. Previous meta-analyses and randomized controlled trials have shown that pulmonary rehabilitation (PR) after a COPD exacerbation can reduce the risk of readmission and death. These studies were limited by small sample sizes, variability, and limited generalizability so this study aimed to determine the association between initiation of PR and rehospitalization with a more diverse population and clinical settings.
Study design: Retrospective observational cohort study
Setting: 4,446 US hospitals in 2014
Synopsis: 197,376 Medicare beneficiaries aged >66 years that were hospitalized for a COPD exacerbation and who survived >30 days post-discharge were included. The initiation of PR within 90 days of discharge when compared to no initiation of PR (or the initiation of PR >90 days post-discharge) was associated with a lower all-cause readmission rate at one year (56.4% versus 64.6%) and a lower mean number of rehospitalizations (1.2 versus 1.5; P <0.001). Also, in the cohort who received PR within 90 days after discharge, the mean cumulative number of rehospitalizations at one year for any reason was lower in comparison to the cohort who did not receive PR (0.95 versus 1.15 readmissions). The number of days spent in the hospital was also lower in the cohort who received PR within 90 days of discharge versus those in the cohort who did not receive PR (7.9 versus 11.7 days).
Bottom Line: In routine practice, the initiation of PR within 90 days after discharge from a hospitalization for COPD exacerbation leads to a lower risk of rehospitalization.
Citation: Stefan MS, et al. Association between initiation of pulmonary rehabilitation and rehospitalizations in patients hospitalized with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021;204(9):1015-1023. doi:10.1164/rccm.202012-4389OC
Ms. Langford is a physician assistant at Atrium Health Wake Forest Baptist, Winston-Salem, N.C.