Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19

Abstract

Background: Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care.

Objective: To describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or required readmission within 14 days of discharge.

Design: Retrospective cohort study of SARS-COV-2-positive patients with index hospitalization between February 27 and April 12, 2020, with ≥ 14-day follow-up. Significance was defined as P < 0.05 after multiplying P by 125 study-wide comparisons.

Participants: Hospitalized patients with confirmed SARS-CoV-2 discharged alive from five New York City hospitals.

Main measures: Readmission or return to ED following discharge.

Results: Of 2864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared with patients who did not return, there were higher proportions of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%) among those who returned. Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs 6.7 [3.5, 11.5] days; P_adjusted = 0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; P_adjusted = 0.001). A trend towards association between absence of in-hospital treatment-dose anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, P_adjusted = 0.06). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively.

Conclusions: Return to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned more likely had COPD and hypertension, shorter LOS on index-hospitalization, and lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS, and anticoagulation are associated with reduced readmissions.

Figure 1

Time to return to hospital since discharge for COVID-19-related hospitalization. Cumulative density function of time to return to the ED or readmission illustrates the proportion of patients (N = 103) from each return visit type contributing to the total. For every time point, the proportion of readmitted patients (N = 56) is higher than those who are only seen in the ED and then discharged (N = 47).

Figure 2

Reasons for return to hospital in 103 patients. Among patients who returned to hospital within the 14-day event horizon (N = 103), the majority presented with respiratory distress as the primary reason. SSTI, skin/soft-tissue infections; AMS, altered mental status; Resp Distress, respiratory distress.