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Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission — United States, March–August 2020

Our take —

Among 106,543 patients discharged at one of the 865 US hospitals in the Premier Health Care Database between March and July 2020, 9% were readmitted to the same hospital within two months. Factors associated with readmission included older age, several chronic conditions, and discharge to a skilled nursing facility or home health. These data may be helpful to allocate healthcare resources for follow-up care of COVID-19 patients. However, reliance on electronic medical records and heterogenous readmission reasons underscore the need for more research to understand the long term-sequelae, including hospital readmissions, of COVID-19.

Study design

Case series; Retrospective Cohort

Study population and setting

The Premier Healthcare Database, which collects data from 865 US hospitals, was used to estimate readmission rates among COVID-19 patients who were hospitalized between March and July 2020 with follow-up through August 2020. COVID-19 diagnoses were obtained from ICD-10-CM codes, and readmission for COVID-19 or other health complications that occurred within two months of the initial hospitalization were considered. Chronic conditions were identified from ICD-10-CM during or before the initial hospitalization, and COVID-19 disease severity was defined by hospital billing records (ICU admission, invasive mechanical ventilation, or noninvasive mechanical ventilation).

Summary of Main Findings

Of the 126,137 patients who were hospitalized for COVID-19 between March and June 2020, 106,543 were discharged alive, and among those, 9,504 (9%) were readmitted to the same hospital in the following two months (median time to readmission: 8 days, IQR: 3-20), and 1.6% of people had multiple readmissions. In multivariable analyses, readmission was more common for individuals with older age (age >65), white race, specific chronic conditions (COPD, heart failure, diabetes, and chronic kidney disease), a history of hospitalization in the three months prior to the admission for COVID-19, and who were discharged to a skilled nursing facility or home health organization. The most frequent discharge diagnoses for readmissions were infectious and parasitic diseases (45%), circulatory (11%), and digestive (7%)

Study Strengths

The sample size was large, and the study included a large number of sites from throughout the US. The multivariable analysis adjusted for a number of important confounding factors, including prior hospitalizations.

Limitations

There is no referent group, so it is not clear how the rate of readmission compares to readmission from other viruses; based on quick literature review, between 8 and 27% following hospitalization for severe pneumonia among Medicare enrollees. ICD-10-CM codes were used to define COVID-19 diagnosis and chronic conditions, which is subject to misclassification, likely under-reporting. Only patients readmitted to the same hospital were considered as readmissions, which may have underestimated the overall rate of readmission. More than half of discharge diagnoses from the hospital readmission were for reasons other than parasitic or infectious diseases (including COVID-19), and the study did not distinguish between readmissions based on their likely relationship (direct or indirect) to COVID-19.

Value added

This was a large, multi-center study, estimating the rate of readmission among patients discharged after hospitalization with COVID-19.

This review was posted on: 20 November 2020