A study published in the Journal of General Internal Medicine found that return to hospital after admission for coronavirus disease 2019 (COVID-19) was infrequent within 14 days of discharge and respiratory distress was the most common cause for return. Further, returning patients were more likely to have a history of chronic obstructive pulmonary disease (COPD) and hypertension and had shorter length of stay and lower frequency of therapeutic anticoagulation use during their index hospitalisation.
“When larger sample sizes become available, the conceptual framework and preliminary trends in this study can help guide future research in understanding determinants of safe discharge and appropriate in-hospital treatment for preventing readmission and death following a COVID-19 hospitalisation,” wrote Sulaiman S. Somani, Icahn School of Medicine at Mount Sinai, New York, New York, and colleagues.
To examine the clinical characteristics of patients with COVID-19 who return to the emergency department or who require readmission within 14 days of discharge, the researchers retrospectively studied a cohort of 2,864 patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with index hospitalisation between February 27 and April 12, 2020, who were discharged from 5 hospitals in New York City.
Of the discharged patients, 103 (3.6%) returned to the hospital for emergency careafter a median of 4.5 days, with 56 (54.4%) requiring inpatient readmission. The most common reason for return was respiratory distress (50%).
The researchers found that compared with patients who did not return to the hospital, there were higher proportions of COPD (6.8% vs 2.9%, Padjusted = 0.035) and hypertension (35.0% vs 22.1%, Padjusted = 0.003) among those who returned. Patients who returned also had a shorter median length of stay during their first hospitalisation (4.7 days vs 6.7 days, Padjusted = 0.006), and were less likely to have required intensive care during their first hospitalisation (5.8% vs 19.0%, Padjusted = 0.001).
The study also found a clinically significant, but not statistically significant, lower frequency of therapeutic anticoagulation use during index hospitalisation among patients who re-presented to the hospital when compared with those who did not (20.9% vs 30.9%, Padjusted = 0.06).
Further, upon readmission, rates of intensive care and death were 5.8% and 3.6%, respectively.
Meanwhile, the researchers found no difference in age, sex, or race/ethnicity in patients returning to the hospital compared with those patients who did not return within 14 days.
“To the best of our knowledge, this is the first report characterizing early return to hospital following discharge in COVID-19 patients across multiple hospital centers,” the authors wrote, adding that findings from this study may offer implications for the post-discharge care of patients hospitalised with COVID-19, and if verified, could inform resource allocation.