Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

Abstract

Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources.Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroenterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n = 43; 40.5%) mostly had 4-5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46; 95% CI: 1.24-5.67), days between discharge/first readmission (PR: 2.21; 95% CI: 1.15-5.88), and pulmonary involvement (≥50%; PR: 1.59; 95% CI: 1.11-3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

COVID‐19 pandemic in Southern Brazil: Hospitalizations, intensive care unit admissions, lethality rates, and length of stay between March 2020 and April 2022

“…Interestingly we note that patients who were admitted to the ICU had higher LOS. Despite administrative prioritization to reduce LOS and ICU admission, studies about COVID‐19 have suggested these two outcomes may be related 13,15–17 . Reducing LOS during the COVID‐19 pandemic has also been emphasized to preserve resources and limit exposure.…”

“…More recently, the spread of the omicron variant has returned the alert for the progression and evolution of the pandemic, even though mass vaccination and herd immunity were already established, the number of cases and occupations in the intensive care unit (ICU) were worrying between January and March 2022 10–12 . In this sense, it is essential to study the outcomes of hospitalizations, ICU admission, use of mechanical ventilation, readmissions, and lethality to qualify and quantify the impact of COVID‐19 on the hospital system 5–9,13–15 …”

“… 10 , 11 , 12 In this sense, it is essential to study the outcomes of hospitalizations, ICU admission, use of mechanical ventilation, readmissions, and lethality to qualify and quantify the impact of COVID‐19 on the hospital system. 5 , 6 , 7 , 8 , 9 , 13 , 14 , 15 …”

“…[10][11][12] In this sense, it is essential to study the outcomes of hospitalizations, ICU admission, use of mechanical ventilation, readmissions, and lethality to qualify and quantify the impact of COVID-19 on the hospital system. [5][6][7][8][9][13][14][15] Therefore, the present study aims to evaluate the number of hospitalizations, ICU admissions, mortality rates, use of mechanical ventilation, and length of stay (LOS) in COVID-19 admission between March 2020 and April 2022 in southern Brazil.…”

“…13,[15][16][17] Reducing LOS during the COVID-19 pandemic has also been emphasized to preserve resources and limit exposure. Further, we observed returning patients were more likely to have required ICU stay during the LOS.…”