• Jeffrey L Schnipper, Sandra Oreper, Colin C Hubbard, Dax Kurbegov, Shanna A Arnold Egloff, Nader Najafi, Gilmer Valdes, Zishan Siddiqui, Kevin J O 'Leary, Leora I Horwitz, Tiffany Lee, and Andrew D Auerbach.
• Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. jschnipper@bwh.harvard.edu.
• J Gen Intern Med. 2024 Nov 1; 39 (14): 264926612649-2661.

BackgroundPatients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing of discharge a clinical and operational challenge.ObjectiveTo determine risks for post-discharge readmission and death among patients hospitalized with COVID-19.DesignMulticenter retrospective observational cohort study, 2020-2021, with 30-day follow-up.ParticipantsAdults admitted for care of COVID-19 respiratory disease between March 2, 2020, and February 11, 2021, to one of 180 US hospitals affiliated with the HCA Healthcare system.Main MeasuresReadmission to or death at an HCA hospital within 30 days of discharge was assessed. The area under the receiver operating characteristic curve (AUC) was calculated using an internal validation set (33% of the HCA cohort), and external validation was performed using similar data from six academic centers associated with a hospital medicine research network (HOMERuN).Key ResultsThe final HCA cohort included 62,195 patients (mean age 61.9 years, 51.9% male), of whom 4704 (7.6%) were readmitted or died within 30 days of discharge. Independent risk factors for death or readmission included fever within 72 h of discharge; tachypnea, tachycardia, or lack of improvement in oxygen requirement in the last 24 h; lymphopenia or thrombocytopenia at the time of discharge; being ≤ 7 days since first positive test for SARS-CoV-2; HOSPITAL readmission risk score ≥ 5; and several comorbidities. Inpatient treatment with remdesivir or anticoagulation were associated with lower odds. The model's AUC for the internal validation set was 0.73 (95% CI 0.71-0.74) and 0.66 (95% CI 0.64 to 0.67) for the external validation set.ConclusionsThis large retrospective study identified several factors associated with post-discharge readmission or death in models which performed with good discrimination. Patients 7 or fewer days since test positivity and who demonstrate potentially reversible risk factors may benefit from delaying discharge until those risk factors resolve.© 2024. The Author(s).

23 keywords...

hide…