The US Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report has found that 9% of patients discharged from an initial coronavirus disease 2019 (COVID-19) hospitalization were readmitted to the same hospital within 2 months of discharge. In addition, multiple readmissions occurred in 1.6% of patients.
Using electronic health record and administrative data from the Premier Healthcare Database, which includes discharge records from 865 nongovernmental, community, and teaching hospitals that contributed inpatient data from March to August 2020, the CDC assessed patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient’s initial COVID-19 hospitalization (index hospitalization).
Among 126,137 patients hospitalized for COVID-19 from March to July 2020, 15% of patients were admitted to an ICU, 13% required invasive mechanical ventilation, and 4% required noninvasive ventilation. Approximately 15% of patients (19,594) died during the index hospitalization. Among 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 median interval from discharge to first readmission was 8 days (interquartile range [IQR], 3–20 days). Less than 0.1% of patients died during readmission. Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among patients discharged to home or self-care (7%).
When controlling for covariates, the odds of readmission increased with the presence of chronic obstructive pulmonary disease (odds ratio [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. Additionally, 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. Meanwhile, compared with persons aged 18–39 years, the odds of readmission increased with age among persons aged ≥65 years (OR, 1.2 to 1.4). Non-Hispanic White persons were also more likely to be readmitted than were those of other racial/ethnic groups. Common primary discharge diagnoses after readmission were infectious and parasitic diseases (primarily COVID-19; 45%) and diseases of the circulatory (11%) and digestive (7%) systems.
“These results support recent analyses that found chronic conditions to be significantly associated with hospital readmission and could be explained by the complications of underlying conditions in the presence of COVID-19, COVID-19 sequelae, or indirect effects of the COVID-19 pandemic,” the report noted. “Understanding the frequency of, and risk factors for, readmission can inform clinical practice, discharge disposition decisions, and public health priorities such as health care planning to ensure availability of resources needed for acute and follow-up care of COVID-19 patients. With the recent increases in cases nationwide, hospital planning can account for these increasing numbers along with the potential for at least 9% of patients to be readmitted, requiring additional beds and resources.”
Nonetheless, the report acknowledged that there was a potential misclassification of cases as COVID-19 diagnoses were determined by ICD-10-CM, not through laboratory confirmation and that primary discharge diagnosis was used to infer the primary reason for hospital admission, noting that other diagnoses might have contributed to the reason for index admission and readmissions. In addition, patients who received care at different hospitals would not be assessed longitudinally.