Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19

Abstract

BACKGROUND: Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. OBJECTIVE: To describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or required readmission within 14 days of discharge. DESIGN: Retrospective cohort study of SARS-COV-2positive patients with index hospitalization between February 27 and April 12, 2020, with ≥ 14-day follow-up. Significance was defined as P < 0.05 after multiplying P by 125 study-wide comparisons. PARTICIPANTS: Hospitalized patients with confirmed SARS-CoV-2 discharged alive from five New York City hospitals. MAIN MEASURES: Readmission or return to ED following discharge. RESULTS: Of 2864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared with patients who did not return, there were higher proportions of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%) among those who returned. Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs 6.7 [3.5, 11.5] days; P adjusted = 0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; P adjusted = 0.001). A trend towards association between absence of in-hospital treatment-dose anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, P adjusted = 0.06). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively. CONCLUSIONS: Return to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned more likely had COPD and hypertension, shorter LOS on index-hospitalization, and lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS, and anticoagulation are associated with reduced readmissions.

Discharge characteristics and care transitions of hospitalized patients with COVID-19

“… 3 , 4 , 5 The readmission rate of 5.2% observed in our study is within the range of other reports. 3 , 13 , 14 , 15 …”

Readmissions among patients with COVID‐19

“…Other reasons for readmission included: pain, altered mental status, falls, fever, soft tissue infection, thrombotic events and gastrointestinal symptoms 3‐8 . A retrospective study from New York demonstrated that among comorbidities, chronic obstructive pulmonary disease (COPD), immunosuppression and hypertension are associated with increased risk for readmission 6 . A case‐control study from Spain confirmed the immunosuppression as a risk factor, whereas did not find an association with COPD 3 .…”

“…A case‐control study from Spain confirmed the immunosuppression as a risk factor, whereas did not find an association with COPD 3 . However, both studies showed that a shorter length of stay is increasing the risk for hospital return 3,6 . Fever within 48 hours prior to discharge, and insufficient anticoagulation during index admission were also reported as potential risk factors for readmissions 3,6 .…”

Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020

“…Coronavirus disease 2019 (COVID-19) is a complex clinical illness with potential complications that might require ongoing clinical care ( 1 – 3 ). Few studies have investigated discharge patterns and hospital readmissions among large groups of patients after an initial COVID-19 hospitalization ( 4 – 7 ). Using electronic health record and administrative data from the Premier Healthcare Database, * CDC assessed patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient’s initial COVID-19 hospitalization (index hospitalization).…”