Published in:
01-08-2021 | COVID-19 | Original Research
Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection
Authors:
Justin R. Kingery, MD/PhD, Paul BF Martin, MD, Ben R. Baer, MS, Laura C. Pinheiro, PhD, Mangala Rajan, MBA, Adrienne Clermont, MSPH, Sabrina Pan, BS, Khoi Nguyen, BA, Khalid Fahoum, MSc, Graham T. Wehmeyer, MD, Mark N. Alshak, MD, Han A. Li, MD, Justin J. Choi, MD, Martin F. Shapiro, MD, Margaret L. McNairy, MD/MSc, Monika M. Safford, MD, Parag Goyal, MD
Published in:
Journal of General Internal Medicine
|
Issue 8/2021
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ABSTRACT
Background
The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes.
Objective
To determine 30-day post-hospitalization outcomes following COVID-19 infection.
Design
Retrospective cohort study
Setting
Quaternary referral hospital and community hospital in New York City.
Participants
COVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.
Measurement
Outcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.
Results
Thirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00–1.02]), diabetes (1.54 [1.06–2.23]), and the need for inpatient dialysis (3.78 [2.23–6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05–1.11]) and Asian race (2.89 [1.27–6.61]) were significantly associated with mortality.
Conclusions
Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.