Risk factors for hospital readmission in chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background: Patients with chronic obstructive pulmonary disease (COPD) commonly experience acute exacerbations that require hospitalization and may lead to repeated COPD-related readmissions. Among patients who survive an index hospitalization, early readmission due to acute exacerbation of COPD remains a major clinical challenge. Therefore, evaluating readmission rates at different follow-up time points and identifying factors associated with readmission are important for improving COPD management. Better risk assessment and early recognition of high-risk patients may support targeted interventions, reduce avoidable readmissions, and improve quality of life and clinical outcomes. Objective: This study aimed to systematically summarize COPD-related readmission rates within 1 month, 3 months, 6 months, and 1 year after hospital discharge, and to identify factors associated with COPD-related readmission. Methods: Eight electronic databases were searched from inception to October 1, 2026, to identify observational studies reporting COPD-related readmission. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies and an adapted NOS for cross-sectional studies. Pooled estimates of readmission rates and factors associated with readmission among patients with COPD were calculated using random-effects models. Results: A total of 54 studies were included, reporting 25 outcome indicators. The pooled readmission rates after discharge were 15.2% within 1 month, 26.90% within 3 months, 30.40% within 6 months, and 42.10% within 1 year. In total, 26 factors associated with readmission were identified. Overall, the methodological quality of the included studies was moderate to high. Conclusion: This meta-analysis examined readmission rates and factors associated with readmission among patients with COPD. The findings show that the 1-year readmission remains common and is influenced by multiple clinical factors. These results underscore the need for early identification of high-risk patients and timely interventions to improve long-term COPD management. Sensitivity analyses showed that the findings were stable, and the included studies were generally of moderate to high methodological quality, supporting the reliability and clinical relevance of the conclusions. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261286213, Identifier CRD420261286213.