Thirty-day post-discharge outcomes following COVID-19 infection

Justin R. Kingery; Paul BF Martin; Ben R. Baer; Laura C. Pinheiro; Mangala Rajan; Adrienne Clermont; Sabrina Pan; Khoi Nguyen; Khalid Fahoum; Graham T. Wehmeyer; Mark N. Alshak; Han A. Li; Justin J. Choi; Martin F. Shapiro; Margaret L. McNairy; Monika M. Safford; Parag Goyal

doi:10.1007/s11606-021-06924-0

Thirty-day post-discharge outcomes following COVID-19 infection

Justin R. Kingery^*, Paul BF Martin, Ben R. Baer, Laura C. Pinheiro, Mangala Rajan, Adrienne Clermont, Sabrina Pan, Khoi Nguyen, Khalid Fahoum, Graham T. Wehmeyer, Mark N. Alshak, Han A. Li, Justin J. Choi, Martin F. Shapiro, Margaret L. McNairy, Monika M. Safford, Parag Goyal

^*Corresponding author for this work

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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.

Original language	English
Pages (from-to)	2378-2385
Number of pages	8
Journal	Journal of General Internal Medicine
Volume	36
Issue number	8
Early online date	7 Jun 2021
DOIs	https://doi.org/10.1007/s11606-021-06924-0
Publication status	Published - 1 Aug 2021

Keywords

COVID-19
Discharge
Mortality
Re-admission

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10.1007/s11606-021-06924-0

https://pmc.ncbi.nlm.nih.gov/articles/PMC8183585/

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Kingery, J. R., Martin, P. BF., Baer, B. R., Pinheiro, L. C., Rajan, M., Clermont, A., Pan, S., Nguyen, K., Fahoum, K., Wehmeyer, G. T., Alshak, M. N., Li, H. A., Choi, J. J., Shapiro, M. F., McNairy, M. L., Safford, M. M., & Goyal, P. (2021). Thirty-day post-discharge outcomes following COVID-19 infection. Journal of General Internal Medicine, 36(8), 2378-2385. https://doi.org/10.1007/s11606-021-06924-0

@article{4979f912e72f4ee9bbba015f8b6c6c2c,

title = "Thirty-day post-discharge outcomes following COVID-19 infection",

abstract = "BackgroundThe 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.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-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.ConclusionsAmong 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.",

keywords = "COVID-19, Discharge, Mortality, Re-admission",

author = "Kingery, {Justin R.} and Martin, {Paul BF} and Baer, {Ben R.} and Pinheiro, {Laura C.} and Mangala Rajan and Adrienne Clermont and Sabrina Pan and Khoi Nguyen and Khalid Fahoum and Wehmeyer, {Graham T.} and Alshak, {Mark N.} and Li, {Han A.} and Choi, {Justin J.} and Shapiro, {Martin F.} and McNairy, {Margaret L.} and Safford, {Monika M.} and Parag Goyal",

note = "Funding: This study received support from the Weill Cornell Clinical and Translational Science Center (CTSC) (UL1 TR000457). Dr. Kingery is supported by the National Institutes of Health/National Heart Lung Blood Institute grant K23-HL-152926. Dr. Choi is supported by the National Institutes of Health/National Center for Advancing Translational Sciences grant KL2-TR-002385.",

year = "2021",

month = aug,

day = "1",

doi = "10.1007/s11606-021-06924-0",

language = "English",

volume = "36",

pages = "2378--2385",

journal = "Journal of General Internal Medicine",

issn = "0884-8734",

publisher = "Springer",

number = "8",

}

Kingery, JR, Martin, PBF, Baer, BR, Pinheiro, LC, Rajan, M, Clermont, A, Pan, S, Nguyen, K, Fahoum, K, Wehmeyer, GT, Alshak, MN, Li, HA, Choi, JJ, Shapiro, MF, McNairy, ML, Safford, MM & Goyal, P 2021, 'Thirty-day post-discharge outcomes following COVID-19 infection', Journal of General Internal Medicine, vol. 36, no. 8, pp. 2378-2385. https://doi.org/10.1007/s11606-021-06924-0

TY - JOUR

T1 - Thirty-day post-discharge outcomes following COVID-19 infection

AU - Kingery, Justin R.

AU - Martin, Paul BF

AU - Baer, Ben R.

AU - Pinheiro, Laura C.

AU - Rajan, Mangala

AU - Clermont, Adrienne

AU - Pan, Sabrina

AU - Nguyen, Khoi

AU - Fahoum, Khalid

AU - Wehmeyer, Graham T.

AU - Alshak, Mark N.

AU - Li, Han A.

AU - Choi, Justin J.

AU - Shapiro, Martin F.

AU - McNairy, Margaret L.

AU - Safford, Monika M.

AU - Goyal, Parag

N1 - Funding: This study received support from the Weill Cornell Clinical and Translational Science Center (CTSC) (UL1 TR000457). Dr. Kingery is supported by the National Institutes of Health/National Heart Lung Blood Institute grant K23-HL-152926. Dr. Choi is supported by the National Institutes of Health/National Center for Advancing Translational Sciences grant KL2-TR-002385.

PY - 2021/8/1

Y1 - 2021/8/1

N2 - BackgroundThe 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.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-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.ConclusionsAmong 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.

AB - BackgroundThe 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.ObjectiveTo determine 30-day post-hospitalization outcomes following COVID-19 infection.DesignRetrospective cohort studySettingQuaternary referral hospital and community hospital in New York City.ParticipantsCOVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.MeasurementOutcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.ResultsThirty-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.ConclusionsAmong 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.

KW - COVID-19

KW - Discharge

KW - Mortality

KW - Re-admission

U2 - 10.1007/s11606-021-06924-0

DO - 10.1007/s11606-021-06924-0

M3 - Article

SN - 0884-8734

VL - 36

SP - 2378

EP - 2385

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

IS - 8

ER -

Thirty-day post-discharge outcomes following COVID-19 infection

Abstract

Keywords

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