Hospital Readmissions Among Veterans Within 90 Days of Discharge Following Initial Hospitalization for COVID-19

Abstract

Introduction Some patients experience ongoing sequelae after discharge, including rehospitalization; therefore, outcomes following COVID-19 hospitalization are of continued interest. We examined readmissions within 90 days of hospital discharge for veterans hospitalized with COVID-19 during the first 10 months of the pandemic in the US. Methods Veterans hospitalized with COVID-19 at a Veterans Health Administration (VA) hospital from March 1, 2020, through December 31, 2020 were followed for 90 days after discharge to determine readmission rates. Results Of 20,414 veterans hospitalized with COVID-19 during this time period, 13% (n = 2,643) died in the hospital. Among survivors (n = 17,771), 16% (n = 2,764) were readmitted within 90 days of discharge, with a mean time to readmission of 21.6 days (SD = 21.1). Characteristics of the initial COVID-19 hospitalization associated with readmission included length of stay, mechanical ventilator use, higher comorbidity index score, current smoking, urban residence, discharged against medical advice, and hospitalized from September through December 2020 versus March through August 2020 (all P values <.02). Veterans readmitted from September through December 2020 were more often White, lived in a rural or highly rural area, and had shorter initial hospitalizations than veterans hospitalized earlier in the year. Conclusion Approximately 1 of 6 veterans discharged alive following a COVID-19 hospitalization from March 1 through December 31, 2020, were readmitted within 90 days. The longer the hospital stay, the greater the likelihood of readmission. Readmissions also were more likely when the initial admission required mechanical ventilation, or when the veteran had multiple comorbidities, smoked, or lived in an urban area. COVID-19 hospitalizations were shorter from September through December 2020, suggesting that hospital over-capacity may have resulted in earlier discharges and increased readmissions. Efforts to monitor and provide support for patients discharged in high bed–capacity situations may help avoid readmissions.

Rural-urban Differences in Long-term Mortality and Readmission Following COVID-19 Hospitalization, 2020 to 2023

“…This multicenter study of the patients hospitalized for COVID-19 between March 2020 and July 2022 (followed through May 2023) with longer follow-up than previously reported [ 7–10 , 15 , 16 ] highlights several novel findings. First, rurality emerged as a strong predictor of higher long-term risk of death independent of 31 covariates from multiple domains, which were previously known to impact COVID-19 outcomes [ 6 , 16–22 ].…”

“…This multicenter study of the patients hospitalized for COVID-19 between March 2020 and July 2022 (followed through May 2023) with longer follow-up than previously reported [ 7–10 , 15 , 16 ] highlights several novel findings. First, rurality emerged as a strong predictor of higher long-term risk of death independent of 31 covariates from multiple domains, which were previously known to impact COVID-19 outcomes [ 6 , 16–22 ]. Patients living in rural areas, as opposed to urban areas, experienced a 4% absolute increase in mortality, indicating that rurality was linked to one additional death for every 25 patients hospitalized for COVID-19 at a median follow-up of 602 days.…”

“…With the exception of the early stages of the pandemic, short-term mortality rates attributed to COVID-19 have consistently been higher among rural than in urban residents [ 4 , 5 , 18 , 25 , 26 ]. These studies focused on shorter timeframes for mortality and were primarily conducted during the early stages of the pandemic, which limits direct comparisons with the current study [ 16 , 34 ].…”

“…In this study, we analyzed baseline differences in sociodemographic factors, comorbidities, admission service, and the year of the pandemic, uncovering disparities in outcomes between rural and urban areas. We found that rural patients had higher rates of comorbidities such as obesity, heart failure, chronic obstruction pulmonary disease, depression, and substance use, which have been previously associated with poorer outcomes [ 6 , 16–22 ]. Additionally, we observed that rural patients with COVID-19 were more likely to be admitted to critical care and pulmonary services compared with their urban counterparts, which was associated with poorer clinical outcomes.…”

Thirty-Day readmissions among COVID-19 patients hospitalized during the early pandemic in the United States: Insights from the Nationwide Readmissions Database

“…A higher Elixhauser Comorbidity Index was associated with higher risk for readmission; alcoholic liver cirrhosis, non-alcoholic steatohepatitis, and congestive heart failure were particularly strong predictors of 30-day readmission. 18 , 21 The association between increased COVID-19 severity and cirrhosis has been well-characterized. 22.…”