• Finlay A McAlister, Yuan Dong, Anna Chu, Xuesong Wang, Erik Youngson, Kieran L Quinn, Amol Verma, Jacob A Udell, YuAmy Y XAYXDivision of General Internal Medicine, Faculty of Medicine and Dentistry (McAlister), University of Alberta; The Alberta Strategy for Patient-Oriented Research Support Unit (McAlister, Dong, Youngson), Edmonton, Alta.; ICES (Chu, Wang, Quinn, , Fahad Razak, Chester Ho, Charles de Mestral, Heather J Ross, Carl van Walraven, Douglas S Lee, and CORONA Collaboration.
• Division of General Internal Medicine, Faculty of Medicine and Dentistry (McAlister), University of Alberta; The Alberta Strategy for Patient-Oriented Research Support Unit (McAlister, Dong, Youngson), Edmonton, Alta.; ICES (Chu, Wang, Quinn, Udell, de Mestral, van Walraven, Lee); University of Toronto (Chu, de Mestral, Ross); Department of Medicine, Divisions of General Internal Medicine and Palliative Care (Quinn), Sinai Health System, University of Toronto; Li Ka Shing Knowledge Institute (Verma, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Razak), University of Toronto; Institute of Health Policy, Management and Evaluation (Verma, Razak), Dalla Lana School of Public Health, University of Toronto; University Health Network (Udell, Ross, Lee); Department of Medicine (Neurology) (Yu), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Division of Physical Medicine and Rehabilitation (Ho), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Department of Surgery (de Mestral), Unity Health Toronto; Peter Munk Cardiac Center (Ross, Lee), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine and School of Epidemiology and Public Health (van Walraven), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont. Finlay.McAlister@ualberta.ca.
• CMAJ. 2022 May 16; 194 (19): E666-E673.

BackgroundThe 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.MethodsWe 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.ResultsOf 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.InterpretationDeath 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.© 2022 CMA Impact Inc. or its licensors.

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