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Although much has been written about the extent to which patients with COVID-19 have been either hospitalised or died, far less attention has been paid to what happens to those who have been successfully treated and discharged from hospital.
COVID-19 has meant hospitalisation for hundreds of thousands of people. While a huge number have sadly died, many more have been successfully discharged but there are limited data examining the subsequent outcomes for these patients. In a study of survivor outcomes, a team from the Department of Learning Health Sciences, University of Michigan, US, decided to examine what happens to a a group of patients initially admitted and then at a later time point, discharged from hospital.
The team focused on index hospitalisations for COVID-19 among veterans at 132 hospitals admitted between March and June 2020. Included patients were either definitely hospitalised because of COVID-19 or hospitalised with probable COVID-19 and for which infection was later confirmed during their period in hospital. For comparative purposes, the team identified a cohort of patients hospitalised for non-COVID-19 pneumonia and heart failure over the same period of time. The researchers measured re-admission and death to 60 days after discharge among those originally admitted and hospitalised because of COVID-19. They recorded the reasons for re-admission, use of intensive care units, mechanical ventilation and vasopressor use during re-admission.
Findings
From the initial 2179 index hospitalisations due to COVID-19, a total of 1775 (81.5%) survived to be discharged. Within 60 days of discharge, 479 (27%) of these discharged patients were re-admitted to hospital and 162 (9.1%) died. The most common reasons for re-admission was COVID-19 (30.2%), sepsis (8.5%), pneumonia (3.1%) and heart failure (3.1%). Moreover, during re-admission, 22.6% required intensive care treatment, 7.1% were mechanically ventilated and 7.9% received vasopressors. Compared with patients hospitalised with either non-COVID pneumonia (1799) or heart failure (3505), COVID-19 patients actually had lower rates of readmission within 60 days but higher rates within 10 days of discharge.
The authors concluded by noting that while much surveillance is focused on inpatient mortality from COVID-19, this data substantially underestimates the burden of the disease.
Citation
Donnelly JP et al. Readmission and death after initial hospital discharge among patients with COVID-19 in a large multinational hospital. JAMA doi:10.1001/jama.2020.21465
