Identifying risk factors for early readmission or death is essential for both the in-hospital clinical team and the primary care physician who assumes care after discharge, as well as transition coordinators determining which patients may benefit from additional resources at discharge to optimize outcomes.

According to new research published in CMAJ, death or readmission was common for patients discharged following hospitalization for COVID-19, with roughly 11% being readmitted or dying within 30 days.

Readmissions to the hospital are common and costly. Understanding the readmission rate after COVID-19 hospitalization and the resource implications can aid with health-care planning.

Researchers examined data from all persons hospitalized in Alberta and Ontario for SARS-CoV-2 between January 1, 2020, and September 30, 2021. Half of Canada’s population lives in Ontario and Alberta. 5.5 percent (46 412) of adults who tested positive for SARS-CoV-2 by PCR were hospitalized; the average length of stay was 8 days; 14 percent were in the intensive care unit at some point during hospitalization; 18 percent (8496) died in hospital; and 11 percent who were discharged alive were readmitted or died within 30 days. Nearly half of the readmissions were due to pulmonary issues.

Patients with COVID-19 had greater rates of in-hospital death and longer durations of stay than patients with other respiratory infections, but readmission rates were not higher than for other medical illnesses.

“Despite fears of high rates of readmission after COVID-19 hospitalizations, we found that outcomes in the 30 days after discharge were consistent with admissions for other medical diagnoses,” write the authors. “Thus, current system approaches to transitioning patients from hospital to home do not appear to need adjustment.”

Patients who died were older, had more comorbidities, were more likely to be male, had been discharged with home care or to a long-term care facility, and had had more previous hospitalizations and emergency department visits.

In both jurisdictions, 91 percent of COVID-19 patients in Alberta and 95 percent in Ontario were unvaccinated, demonstrating the effectiveness of immunizations.

The authors point out that their outcome data excludes cases of “long COVID,” which may not necessitate hospitalization but can have an impact on health-care utilization.

“Future research should determine other system effects for COVID-19 survivors, particularly with respect to postacute COVID-19 symptomatology,” write the authors.

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