Tuesday, November 10, 2020

MMWR: Readmission Of COVID-19 Patients Within 2 Months Of Hospital Discharge

#15,549


COVID-19 has produced a relatively high morbidity - low mortality pandemic; and while several times deadlier than than seasonal flu, is has not been as lethal as might be expected from MERS-CoV, SARS, or avian H5N1, H5N6, or H7N9.  

This `good news' is tempered somewhat by numerous reports of slow recoveries and/or lingering illness among survivors.  Unlike influenza - which is primarily a pulmonary infection - COVID-19 appears to launch a more systemic attack (see Nature Med. Review: Extrapulmonary manifestations of COVID-19).


Although it still appears that most COVID cases experience a relatively mild and self-limiting illness, for months we've been following reports of chronic illness ( aka `Long COVID'), or sequelae related to the initial infection (see UK NIHR: Living With COVID-19 (Long COVID)).

Some past blogs include:
 
Eurosurveillance: Reduced Maximal Aerobic Capacity After COVID-19 In Young Adult Recruits

JASN: Acute Kidney Injury In Hospitalized Patients With COVID-19


JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury

The Lancet: Yet Another Study On Neurological Manifestations In Severe COVID-19 Patients

Over the past few months we've seen cardiologists and neurologists weigh in on the potential for seeing huge increases in COVID-19 related heart failure and neurological diseases, some that may not become fully apparent for years.
 
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
 
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
 

Emily A. Troyer, Jordan N. Kohn, and Suzi Hong


Not surprisingly, older patients, and those with comorbidities, are more likely to have a slower or more difficult recovery from COVID-19.  This isn't unique to COVID, of course. Any significant illness in a medically vulnerable patient can trigger a cascade of negative events requiring additional treatment. 

Yesterday the CDC's MMWR published a review of readmissions (within 60 days) of COVID cases discharged from hospitals between March and August, and found that 1 in 11 were readmitted to the same hospital within two months. 

While this doesn't capture all readmissions, or all significant sequelae in discharged (or never hospitalized) COVID cases, it does help illustrate the lingering health impacts of COVID-19, and the ongoing burden this may place on the healthcare delivery system. 

I've only posted excerpts from a much longer report, so follow the link to read it in its entirety. 

Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020
Early Release / November 9, 2020 / 69
Amy M. Lavery, PhD1; Leigh Ellyn Preston, DrPH1; Jean Y. Ko, PhD1; Jennifer R. Chevinsky, MD1; Carla L. DeSisto, PhD1; Audrey F. Pennington, PhD1; Lyudmyla Kompaniyets, PhD1; S. Deblina Datta, MD1; Eleanor S. Click, MD, PhD1; Thomas Golden, MD1; Alyson B. Goodman, MD1; William R. Mac Kenzie, MD1; Tegan K. Boehmer, PhD1; Adi V. Gundlapalli, MD, PhD1 (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Evidence suggests that potential health complications after COVID-19 illness might require ongoing clinical care.
What is added by this report?
After discharge from an initial COVID-19 hospitalization, 9% of patients were readmitted to the same hospital within 2 months of discharge. Multiple readmissions occurred in 1.6% of patients. Risk factors for readmission included age ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the first COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.

What are the implications for public health practice?

Understanding frequency of, and potential reasons for, readmission after a COVID-19 hospitalization can inform clinical practice, discharge disposition decisions, and public health priorities, such as health care resource planning.
(EXCERPT)
Among 126,137 unique patients with an index COVID-19 admission during March–July 2020, 15% died during the index hospitalization. Among the 106,543 (85%) surviving patients, 9% (9,504) were readmitted to the same hospital within 2 months of discharge through August 2020. More than a single readmission occurred among 1.6% of patients discharged after the index hospitalization. Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among patients discharged to home or self-care (7%).
The odds of hospital readmission increased with age among persons aged ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the index hospitalization, and if discharge from the index hospitalization was to a SNF or to home with health care assistance.
          (SNIP)


These results are comparable to those of recently published analyses, which found a similar group of chronic conditions to be significantly associated with hospital readmission (6,7) and could be explained by the complications of underlying conditions in the presence of COVID-19 (8), COVID-19 sequelae (3), or indirect effects of the COVID-19 pandemic (9). Although only a small proportion of patients discharged to home or self-care were readmitted, 7% returned to the hospital within a median of 7 days. One explanation for their readmission is that approximately two thirds of these 4,406 patients had one or more of the selected chronic conditions.
 
After hospitalization for COVID-19, the most common primary discharge diagnoses from hospital readmission were diseases of the circulatory, digestive, or respiratory systems. Future work will examine the detailed diagnoses recorded during readmissions to better understand COVID-19 sequelae or health conditions that require extended or ongoing care. 

 (Continue . . . )

 


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