A new study suggests exploring in more detail possible factors that may lead to readmission of some hospitalized COVID-19 patients within a month of discharge.
The researchers say a readmission rate of roughly 9% is similar to that of other diseases, but socioeconomic factors and gender appear to play a big role in predicting which patients are most likely to be affected once sent home.
The study, published Monday in the Journal of the Canadian Medical Association, looked at 46,412 adults hospitalized with COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18% – 8,496 patients – died in hospital between January 2020 and October 2021, which is higher than normal for other respiratory tract infections.
Among those sent home, about 9% returned to the hospital within 30 days of departure, and 2% died.
The total readmission or death rate was the same in each province: 9.9% or 783 patients in Alberta and 10.6% or 2390 patients in Ontario.
For those wondering if patients were discharged too soon, the report says that most of them spent less than a month in the hospital, and patients who stayed longer were actually readmitted at a slightly faster rate.
“At first we were wondering: “Are people being sent home too early?” … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” said Edmonton-based co-author Dr. Finley McAlister, professor of general internal medicine at the University of Alberta.
“It appears that clinicians were identifying suitable patients to send home.”
The report found that readmitted patients tended to be male, older, had multiple comorbidities, and previous hospital visits and hospitalizations. They were also more likely to be discharged with home care or a long-term care facility.
McAlister also found that socioeconomic status is a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes based on length of stay, age, comorbidities, and past ED visits, but “it wasn’t as good predictor of post-COVID patients”.
“Including things like socioeconomic status, male gender and where they are actually discharged also have a big impact. This brings us back to a common message we see over and over again with COVID: socioeconomic deprivation seems to be even more important to COVID. than with other diseases.
McAlister said knowing this could help transition coordinators and family doctors decide which patients need more care when they leave the hospital.
By itself, LACE had only a modest ability to predict readmission or death, but adding variables, including area of residence and patient gender, improved accuracy by 12%, adds co-author Dr. Amol Verma, general practitioner at St. Michael’s Hospital in Toronto.
The study did not look at how important socioeconomic status itself is, but looked at postcodes associated with so-called “deprivation” indicators, such as lower levels of education and income among residents.
Readmissions were about the same regardless of area, but patients from zip codes with high deprivation index scores from the outset were more likely to be hospitalized with COVID-19, Verma notes.
Verma adds that the use of zip codes has limitations in assessing socioeconomic status, as urban zip codes can vary widely in demographics. He also notes that patients without a zip code were not included in the study.
McAlister said about half of the patients returned due to breathing problems, which is the most common diagnosis in any type of readmission.
He suspected that many of these problems would be difficult to prevent, suggesting that “it could just be the progression of an underlying disease.”
What is clear, however, is that many people who seem to have survived COVID cannot completely get rid of the disease, he added.
“Consideration of readmissions is just the tip of the iceberg. There is some evidence (from the World Health Organization) that between half and two-thirds of people who have COVID severe enough to be hospitalized subsequently have lung or heart problems. if you do enough detailed testing,” he said.
“If you give patients quality-of-life scores and symptom questionnaires, they report far more levels of disability than we get when we analyze hospital admissions or emergency room visits.”
The study period predates the omicron surge that emerged in late 2021, but McAllister said there is no reason to suspect a big difference between today’s patients.
He said that while the effects of omicrons have been shown to be less severe than those of the delta variant, they are comparable to the wild type of the novel coronavirus that caused the pandemic.
“If you’re not vaccinated and you’ve caught omicron, it’s still not a walk in the park,” he said.