Readmissions among patients with COVID-19 may be reduced by promptly recognizing and managing comorbidities and other clinical and demographic risk factors for readmission, according to study results published in Heart & Lung.
Investigators sought to characterize clinical and demographic factors associated with the 30-day all-cause hospital readmission rate for US patients admitted with COVID-19 during the early pandemic.
Using the Nationwide Readmissions Database for 2020, investigators conducted a retrospective study of more than 965,000 adult patients hospitalized for COVID-19 and subsequently discharged. Of these, 30,651 were readmitted (all-cause) within 30 days. The highest percentage of readmissions (39.9%) occurred in patients over 70 years of age (mean age, 63.1 years for women and 62.6 years for men).
Of the readmitted patients, 37.2% had class 3 obesity (body mass index >40kg/m2). Acute kidney injury (29.3%) and acute pulmonary embolism (2.6%) were the most prevalent complications during index hospitalization, and 16.2% of patients at index required mechanical ventilation.
Based on their analysis, investigators estimated the 30-day, all-cause hospital readmission rate for US patients with COVID-19 during this early pandemic period to be 3.2%. Prominent predictors of readmission among patients with COVID-19 included congestive heart failure and chronic alcoholic liver cirrhosis. Pneumonia (3.2%), acute kidney injury (3.2%), congestive heart failure (6.1%) and sepsis (10.3%) were the most common diagnoses at readmission.
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[W]e advise clinicians to promptly recognize patients with COVID-19 who are at high risk of readmission, and to subsequently manage their underlying comorbidities, to institute timely discharge planning, and to allocate resources to underprivileged patients in order to decrease the risk of 30-day hospital readmissions.
Patients at the highest risk of readmission were from economically disadvantaged backgrounds and younger age, and those with the highest percentage of readmissions were older age. Independent demographic predictors of all-cause 30-day readmissions after multivariate regression included younger age (18-29 years; hazard ratio, 1.7; 95% CI, 1.6-1.9), median income below $50,000, and Medicaid payor status.
Mortality during index hospitalization increased dramatically with age (18-29 years, 1.4%; >70 years, 22.3%). Thus, younger age as a predictor for all-cause readmission may derive from attrition bias. Significantly more patients with higher risk of re-admission died during index hospitalization, thereby decreasing the number of older-age readmissions.
Risk of 30-day readmission for patients with COVID-19 was increased in patients at index hospitalization with renal replacement therapy, mechanical ventilation, acute kidney injury, congestive heart failure, and acute coronary syndrome.
Study limitations include potential coding errors in primary diagnosis and underreporting of secondary diagnoses.
“The 30-day hospital readmission rate for COVID-19 patients in the United States during 2020 was 3.2%; sepsis, acute kidney injury, pneumonia, congestive heart failure, and acute pulmonary embolism were the most common diagnoses at readmission,” investigators concluded. “Based on the results of our study, we advise clinicians to promptly recognize patients with COVID-19 who are at high risk of readmission, and to subsequently manage their underlying comorbidities, to institute timely discharge planning, and to allocate resources to underprivileged patients in order to decrease the risk of 30-day hospital readmissions,” said the study authors.
