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COVID: About 9% of patients return to hospital within 30 days

A new study offers a closer look at possible factors that may lead to readmission of some hospitalized COVID-19 patients within a month of discharge.

At around 9%, the researchers say the readmission rate is similar to that seen for other conditions, but socioeconomic factors and gender seem to play a bigger role in predicting which patients are more likely to suffer from a slowdown when they are sent home.

Research published Monday in the Canadian Medical Association Journal examined 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 was above the norm for other respiratory tract infections.

Of those sent home, about 9% returned to hospital within 30 days of leaving, while 2% died.

The combined readmission or death rate was similar in each province, at 9.9% or 783 patients in Alberta and 10.6% or 2,390 patients in Ontario.

For those wondering if patients were discharged too early, the report found that most spent less than a month in hospital, and patients who stayed longer were actually readmitted at a slightly higher rate. raised.

“We first asked ourselves: ‘Have people been sent home too soon?’ …and there was no association between length of hospital stay and readmission rates, which is reassuring,” said co-author Dr. Finlay McAlister, professor of general internal medicine at the University of Alberta, from Edmonton.

“So it seemed like clinicians were identifying the right patients to send home.”

The report found that readmitted patients were generally male, older, and had multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with care at home or in a long-term care facility.

McAlister also found that socioeconomic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits. but “it was not as good a predictor for post-COVID patients.”

“Including things like socio-economic status, male gender and where they were actually sent were also big influences. It goes back to the whole message we see over and over again with COVID: that socio-economic deprivation seems to be far more important for COVID than for other medical conditions.

McAlister said knowing this could help transition coordinators and family physicians decide which patients need extra help when they leave the hospital.

On its own, LACE had only a modest ability to predict readmission or death, but adding variables such as patient’s neighborhood and gender improved accuracy by 12%, adds the co-author of support, Dr. Amol Verma, internal medicine physician at St. Michael’s Hospital. in Toronto.

The study did not determine the extent to which socioeconomic status itself was a factor, but looked at ZIP codes associated with so-called “deprivation” indicators like lower education and income among residents.

Readmission was roughly the same regardless of neighborhood, but patients from zip codes that scored high on the Deprivation Index were more likely to be admitted for COVID-19 to begin with, Verma notes.

Verma adds that the use of postal codes has limitations in assessing socio-economic status since urban postal codes can have wide demographic variation. He also notes that the study did not include patients without a postcode.

McAlister said about half of patients have returned due to difficulty breathing, which is the most common diagnosis for readmissions of any type.

He suspected that many of these problems would have been difficult to prevent, suggesting “it could just be the progression of the underlying disease”.

It is clear, however, that many people who appear to survive COVID are not able to completely put the disease behind them, he added.

“Looking at readmissions is just the tip of the iceberg. There’s data from (the World Health Organization) that maybe half to two-thirds of people who have had COVID severe enough to being hospitalized end up with lung or heart problems afterwards, if you do sufficiently detailed tests, ”he said.

“If you give patients quality of life scores and symptom questionnaires, they report many more levels of disability than what we report in analyzes of hospitalizations or emergency department visits.”

The research period predates the Omicron surge which emerged in late 2021, but McAlister said there was no reason to suspect a big difference between today’s patients.

He said that although Omicron’s results were found to be less severe than the Delta variant, they are comparable to the wild-type novel coronavirus that started the pandemic.

“If you’re not vaccinated and you catch Omicron, it’s still not a walk in the park,” he said.

This report from The Canadian Press was first published on May 16, 2022.

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