Key result
Enhanced risk model predicts 30-day death or readmission affecting 1 in 9 discharged COVID-19 patients.
Why the study?
The frequency of readmissions after COVID-19 hospitalizations and the usefulness of current readmission prediction equations for discharge risk stratification were uncertain.
Cohort (n=34,846)
Yes
Effect estimate: c-statistic 0.73
Death or unplanned readmission within 30 days of discharge for COVID-19 is common, and prediction models are significantly improved by incorporating socioeconomic and demographic factors.
Post-discharge adverse events remain common after COVID-19 hospitalization; extends risk prediction by socioeconomic factors yet leaves open prospective validation.
BACKGROUND: The frequency of readmissions after COVID-19 hospitalizations is uncertain, as is whether current readmission prediction equations are useful for discharge risk stratification of COVID-19 survivors or for comparing among hospitals. We sought to determine the frequency and predictors of death or unplanned readmission after a COVID-19 hospital discharge. METHODS: We conducted a retrospective cohort study of all adults (≥ 18 yr) who were discharged alive from hospital after a nonpsychiatric, nonobstetric, acute care admission for COVID-19 between Jan. 1, 2020, and Sept. 30, 2021, in Alberta and Ontario. RESULTS: Of 843 737 individuals who tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction during the study period, 46 412 (5.5%) were adults admitted to hospital within 14 days of their positive test. Of these, 8496 died in hospital and 34 846 were discharged alive (30 336 discharged after an index admission of ≤ 30 d and 4510 discharged after an admission > 30 d). One in 9 discharged patients died or were readmitted within 30 days after discharge (3173 [10.5%] of those with stay ≤ 30 d and 579 [12.8%] of those with stay > 30 d). The LACE score (length of stay, acuity, Charlson Comorbidity Index and number of emergency visits in previous 6 months) for predicting urgent readmission or death within 30 days had a c-statistic of 0.60 in Alberta and 0.61 in Ontario; inclusion of sex, discharge locale, deprivation index and teaching hospital status in the model improved the c-statistic to 0.73. INTERPRETATION: Death or readmission after discharge from a COVID-19 hospitalization is common and had a similar frequency in Alberta and Ontario. Risk stratification and interinstitutional comparisons of outcomes after hospital admission for COVID-19 should include sex, discharge locale and socioeconomic measures, in addition to the LACE variables.
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McAlister et al. (2022) conducted a cohort in COVID-19 (n=34,846). COVID-19 hospital discharge was evaluated on urgent readmission or death within 30 days (c-statistic 0.73). Death or unplanned readmission within 30 days after COVID-19 hospital discharge occurred in 1 in 9 patients, and an enhanced risk prediction model achieved a c-statistic of 0.73.
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