Published November 18, 2020
Which Patients Are Most Likely to Be Readmitted for COVID-19?
Atlanta, GA—Readmission to the hospital among COVID-19 patients isn’t that unusual, especially among those aged 65 years and older. A new study suggests that certain chronic conditions make that much more likely.
The article in the Morbidity & Mortality Weekly Report discusses the study of 106,543 patients discharged after an index COVID-19 hospitalization. Of those, 9% experienced at least one readmission to the same hospital within 2 months of discharge, and more than one readmission occurred in 1.6% of cases, according to researchers from the CDC.
“In this analysis, the odds of hospital readmission increased with age among persons aged ≥65 years, presence of one of five selected 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,” the authors write.
They also point out, “Although the proportions of patients in the Premier Healthcare Database cohort who were non-Hispanic Black (23%) or Hispanic (21%) were higher than those proportions in the U.S. Census (13% and 18%, respectively), their odds of readmission were lower than those of non-Hispanic White patients. The slight association of readmission with lengths of stay for hospitalized COVID-19 patients merits further study.”
The research shows that, after hospitalization for COVID-19, the most common primary discharge diagnoses from hospital readmission were diseases of the circulatory, digestive, or respiratory systems. Specifically, the following conditions were associated with risk for readmission:
• Chronic obstructive pulmonary disease
• Heart failure
• Diabetes (type 1 or type 2, with chronic complications)
• Chronic kidney disease
• Obesity (body mass index ≥30 kg/m2), including severe obesity, [body mass index ≥40 kg/m2)
“Information on the frequency of, and risk factors for, readmission can inform clinical practice and discharge disposition decisions especially with regard to the acuity and location of ongoing care needed for persons who might appear stable at discharge,” the authors advise. They urge hospitals to plan for the potential for at least 9% of patients to be readmitted, requiring additional beds and resources.
The report describes how, during March–July 2020, 126,137 patients within the Premier Healthcare Database were hospitalized for COVID-19, with most, 81%, admitted from a non–health care setting (81%), followed by transfer from another hospital, clinic, or skilled nursing facility (SNF [18%]). During the index hospitalization, 15% of patients were admitted to an ICU, 13% required invasive mechanical ventilation, and 4% required noninvasive ventilation, with about 15% dying.
Of those patients, 62% of patients had an ICD-10-CM diagnosis code for one or more of the following five chronic conditions: chronic obstructive pulmonary disease (21%), heart failure (16%), diabetes mellitus type 1 or type 2 (27%), chronic kidney disease (21%), or obesity (27%). Overall, 10,008 (8%) patients had been hospitalized at the same hospital in the 3 months preceding their index COVID-19 hospitalization.
Of the 106,543 patients discharged from the index admission, 9,504 (9%) were readmitted, including 1,667 (1.6%) who were readmitted more than once, the authors write, adding that the median interval from discharge to first readmission was 8 days (interquartile range = 3–20 days). Very few, less than 0.1% of patients, died during readmission.
Most of the patients discharged were sent home or to self-care, 60%, while 15% went to a SNF, 10% to home with assistance from a home-health organization, 4% to hospice, 4% to ongoing care, and 5% to other locations. The study determined that readmission was more common among patients discharged to a SNF (15%) or with home health organization support (12%), compared with patients discharged to home or self-care (7%).
When controlling for covariates, researchers report that the odds of readmission increased with the presence of chronic obstructive pulmonary disease (OR = 1.4), heart failure (OR = 1.6), diabetes (OR = 1.2), and chronic kidney disease (OR = 1.6). In addition, patients were more likely to be readmitted if they had been discharged from the index hospitalization to a SNF (OR = 1.4) or with home health organization support (OR = 1.3) than if they had been discharged to home or self-care.
Compared with young adults aged 18–39 years, the odds of readmission increased with age among persons aged 65 years or older. Adjusted odds of readmission of patients with a hospitalization in the 3 months preceding their index hospitalization were 2.6 times the odds of those who were not hospitalized in the preceding 3 months, with non-Hispanic White persons more likely to be readmitted than were those of other racial/ethnic groups, according to the CDC.
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