Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection

Abstract

Background The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes. Objective To determine 30-day post-hospitalization outcomes following COVID-19 infection. Design Retrospective cohort study Setting Quaternary referral hospital and community hospital in New York City. Participants COVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020. Measurement Outcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge. Results Thirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality. Conclusions Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06924-0.

Hospital readmissions and post-discharge all-cause mortality in COVID-19 recovered patients; A systematic review and meta-analysis

“…In the manual search of gray literature and preprints, 18 potentially related papers were included. After reviewing the titles and abstracts of the articles, 157 peer-reviewed papers or preprinted manuscripts were reviewed and a total of 91 articles were entered into the present meta-analysis [ 8 , [14] , [15] , [16] , [17] , [18] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] ,…”

“…The relationship between age and increased post-discharge all-cause mortality of COVID-19 patients has been studied in some studies, the findings of which are sometimes contradictory. Some of these studies show a significant relationship between age and post-discharge all-cause mortality [ 39 , 48 , 60 ], while others do not report such a relationship [ 28 , 63 ]. The elderly population is heterogenous and suffers from various underlying diseases such as dementia, Parkinson's, and delirium, all of which affect the outcome of COVID-19 [ [109] , [110] , [111] ].…”

Readmission rates of patients with COVID-19 after hospital discharge

“…Sixteen (11%) of these patients were readmitted to hospital 11 . In a study with 1344 patients, after discharge from the hospital, 216 (16.5%) patients were reported to return to the hospital for reasons related to COVID-19, 132 (9.8%) were readmitted to the hospital, and 32 (2.4%) of these died in hospital after readmission 3 . In this reported study, return rates were relatively higher but readmissions to the hospital were lower.…”

“…Information about the readmission rate of patients with COVID-19 is insufficient 2 . In two previous studies, readmission rates to the hospital for symptoms related to COVID-19 after discharge were 1.9 and 29.4%, respectively 3,4 . There are very few studies inspecting readmissions of patients with COVID-19 in Turkey.…”

“…In the inspection of readmissions to the hospital after treatment for COVID-19, periods of 14-60 days were considered in different reports 7,8 . A follow-up period of 30 days after discharge is a reliable time to evaluate the development of unwanted outcomes related to COVID-19 3 . Rate of readmission is strongly related to the existence of concomitant diseases, course, severity, and recovery rate of COVID-19 disease.…”