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. 2021 Aug;36(8):2378-2385.
doi: 10.1007/s11606-021-06924-0. Epub 2021 Jun 7.

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

Justin R Kingery #  1   2 , Paul Bf Martin #  3 , Ben R Baer  4 , Laura C Pinheiro  3 , Mangala Rajan  3 , Adrienne Clermont  5 , Sabrina Pan  5 , Khoi Nguyen  5 , Khalid Fahoum  5 , Graham T Wehmeyer  5 , Mark N Alshak  5 , Han A Li  5 , Justin J Choi  3 , Martin F Shapiro  3 , Margaret L McNairy  3   6 , Monika M Safford  3 , Parag Goyal  3   7
Affiliations

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

Justin R Kingery et al. J Gen Intern Med. 2021 Aug.

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.

Keywords: COVID-19; discharge; mortality; re-admission.

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Conflict of interest statement

Dr. Safford has received research support from Amgen. Dr. Choi has received research support and consulting fees from Roche Diagnostics and Allergan unrelated to the work in this manuscript. Dr. Goyal has received personal fees for medicolegal consulting on heart failure.

The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Exclusion cascade describing COVID-19-infected patients included in the analysis.
Figure 2
Figure 2
Kaplan-Meier curve depicting 30-day post-discharge return the emergency room, re-hospitalization, and mortality of cohort patients.
See this image and copyright information in PMC

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