Copd Readmissions in the U.S.: Mortality, Length of Stay, and Healthcare Utilization Analysis from the National Readmission Database

Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare utilization in the United States with acute exacerbations being associated with high rates of early readmission, reflecting disease severity, comorbidity burden, and gaps in post-discharge care. This study aimed to evaluate the national burden of COPD readmissions in the United States using the 2022 National Readmission Database (NRD), with a focus on readmission rates, in-hospital mortality, healthcare utilization, and independent predictors of readmission, including socioeconomic and hospital-level factors. Methods We conducted a retrospective cohort study using the 2022 National Readmission Database, the largest all-payer inpatient readmission dataset in the United States. Adult patients aged ≥ 18 years hospitalized with a primary diagnosis of COPD were identified using ICD-10-CM codes. Primary outcomes included 30-day readmission rates, while secondary outcomes included in-hospital mortality during index and readmission hospitalizations, length of stay, hospital charges and costs, and predictors of readmission. Survey-weighted univariable and multivariable regression models were used to identify independent predictors of readmission. Results 222,347 index COPD hospitalizations were identified nationwide in 2022, of which 219,232 patients were discharged alive and included in the analysis. The mean age was 68.5 years, and 57.5% of patients were female. The overall 30-day all-cause readmission rate was 17.9%, corresponding to approximately 46,490 readmissions nationwide. In-hospital mortality during index admissions was 1.36%, compared with a substantially higher mortality rate of 4.18% during readmissions. In multivariable analyses, higher Charlson Comorbidity Index was the strongest predictor of readmission. Female sex and residence in higher-income neighborhoods were independently associated with lower odds of readmission, while admission to medium or large hospitals was associated with modestly higher readmission risk. Conclusion Almost one in five patients hospitalized for COPD experienced a 30-day readmission in 2022, with readmissions associated with significantly higher in-hospital mortality and substantial healthcare utilization. These findings highlight the need to target transitional care and interventions that address social determinants of health to reduce COPD readmissions and improve outcomes at the national level.