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According to a study conducted in two Canadian provinces, about one in nine patients hospitalized with COVID-19 either died or were readmitted within about a month of discharge from hospital. According to the researchers, this finding is in line with readmission rates observed for other diseases.
In the retrospective analysis of 34,846 patients, 783 (9.9%) patients in Alberta and 2390 (10.6%) patients in Ontario died or were urgently readmitted within 30 days.
Study author Finlay McAllister, MD, professor of medicine at the University of Alberta, Edmonton, Alberta, Canada, wrote the study. “Thus, the approach to the current system for transporting patients from hospital to home does not appear to need to be modified.”
The results were published online on May 16 in Journal of the Canadian Medical Association.
Implications for resource planning
Although governments and the media have focused on hospitalization and mortality rates associated with COVID-19, less attention has been paid to readmissions to hospital after COVID-19. Research examining readmissions to hospital has had significant limitations (such as focusing only on readmissions to standard hospital), and few studies have sought to identify factors that are predictive of readmission.
An incomplete understanding of the rate of hospital readmission after COVID-19 makes patient risk stratification more difficult. It also affects efforts to plan health system resources to respond to new waves of the epidemic.
Researchers examined data on all adults who were hospitalized in Alberta and Ontario between January 1, 2020 and September 30, 2021, within 14 days of a positive SARS-CoV-2 polymerase chain reaction test result.
Data sources included the discharge summaries database, the National Ambulatory Care Reporting System, regional laboratory databases, and regional registration files. Focusing on Ontario and Alberta, the researchers chose provinces that represent 50.3% of Canada’s total population. Both counties openly fund hospital admissions. In addition, the researchers collected data on the vaccination status against SARS-CoV-2.
Because privacy laws prevent health data from being shared across provincial borders, the Alberta analyzes were conducted within the Alberta Strategy Team for Research and Patient-Oriented Data Services, and the Ontario analyzes were conducted at the nonprofit Research Institute ICES. McAllister and co-authors then compiled risk estimates.
The primary study outcome was readmission to hospital for all causes or death within 30 days after discharge from hospital.
Readmission risk factors
During the study period, 46,412 adults were hospitalized within 14 days of having a positive SARS-CoV-2 test. Investigators excluded 5,845 patients in the two counties from the analysis because their index of stay was more than 30 days.
Of the remaining residents, 8,496 died in hospital and 34,846 were left alive. One in nine patients discharged from hospital died or were readmitted within 30 days after discharge. This group included 3173 (10.5%) patients with a duration of hospitalization considered typical by the Canadian Institute of Health Information and 579 (12.8%) patients with a stay of more than 30 days.
Compared with patients in Ontario, patients in Alberta were younger, more likely to live in rural areas, more likely to have had pre-hospital and emergency department visits, more likely to leave the home without support, and less likely to come from long – Term care facility. However, most of the other covariates were similar between provinces.
Patients who died or were readmitted to hospital were older, had an increased burden of comorbid Charleston disease, were more likely to be male, were more likely to be discharged from home with home care or to a long-term care facility, and had the highest rates of admission Previous hospital and emergency department visits.
The five most common initial diagnoses on readmission of patients were COVID-19 (37.6%), unspecified pneumonia or interstitial lung disease (6.0%), heart failure (4.1%), pulmonary embolism (3.1%), and confusion (3.0%). ) .
McAllister said the “other big message” from this research was the continued vulnerability of people who haven’t been vaccinated against serious COVID-19 infections. Medscape Medical News.
Among patients admitted with COVID-19, 91% of patients in Alberta and 95% in Ontario have not been vaccinated. McAllister said COVID-19 has become “a non-immune pandemic, as we’ve probably known for at least the last six or eight months.” “This is just data confirming that.”
Vaccination reduces hospital admissions
Comment on the results for MedscapeCraig Jenne, PhD, an infectious disease researcher at the University of Calgary, Calgary, Alberta, Canada, highlighted the same finding that McAllister cited about the predominance of unvaccinated people among those hospitalized with COVID-19.
“So, again, this confirms that one of the best tools we have is to avoid hospitalization [is] “Vaccination,” Jane said.
Jane also noted that hospitals in Alberta and Ontario had to scramble to respond to the wave of COVID-19 admissions during the study period.
“Despite these very critical challenges, patient care does not appear to have ever suffered, at least for COVID,” Jane said.
This study was supported by a Rapid Research Funding Opportunity grant from the Canadian Institutes of Health COVID-19 Research. Jenne and McAlister report no relevant financial disclosures.
cmg. Posted online May 16, 2022. full text.
Keri Dooley Young is a freelance journalist based in Miami, Florida. She is the lead topic leader on patient safety issues for the Health Care Journalists Association. Follow her on Twitter: Tweet embed
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