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Comorbidities associated with 30-day readmission following index coronavirus disease 2019 (COVID-19) hospitalization: A retrospective cohort study of 331,136 patients in the United States

Published online by Cambridge University Press:  03 October 2022

Gita Nadimpalli Open the ORCID record for Gita Nadimpalli [Opens in a new window] ,
Lyndsay M. O’Hara ,
Laurence S. Magder ,
J. Kristie Johnson ,
Abdolreza Haririan ,
Lisa Pineles ,
Katherine E. Goodman Open the ORCID record for Katherine E. Goodman [Opens in a new window] ,
Jonathan D. Baghdadi Open the ORCID record for Jonathan D. Baghdadi [Opens in a new window] ,
Beth L. Pineles  and
Anthony D. Harris
Gita Nadimpalli
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Lyndsay M. O’Hara
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Laurence S. Magder
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland Department of Pathology, The University of Maryland School of Medicine, Baltimore, Maryland
Abdolreza Haririan
Affiliation:
Division of Nephrology, The University of Maryland School of Medicine, Baltimore, Maryland
Lisa Pineles
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Katherine E. Goodman
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Jonathan D. Baghdadi
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
Beth L. Pineles
Affiliation:
Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
Anthony D. Harris*
Affiliation:
Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland
*
Author for correspondence: Anthony D. Harris, E-mail: aharris@som.umaryland.edu
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Abstract

Objective:

Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission.

Design, setting, and participants:

We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital.

Results:

Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17–1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09–1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58–2.19), renal failure (aOR, 1.32; 95% CI, 1.25–1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24–1.34) were most associated with readmission for COVID-19.

Conclusions:

Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 8 , August 2023 , pp. 1325 - 1333
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Carr, E. COVID-19 pandemic: what have we learned? Clin J Oncol Nurs 2021;25:11–12.CrossRefGoogle ScholarPubMed
Cole, J, Barnard, E. The impact of the COVID-19 pandemic on healthcare-acquired infections with multidrug-resistant organisms. Am J Infect Control 2021;49:653–654.CrossRefGoogle ScholarPubMed
Stone, W, Feibel, C. US COVID hospitalizations hit new record high, raising risks for patients. National Public Radio website. https://www.npr.org/sections/health-shots/2022/01/11/1071568846/u-s-covid-hospitalizations-hit-new-record-high-raising-risks-for-patients. Published January 11, 2022. Accessed May 29, 2022.Google Scholar
Austin, JM, Kachalia, A. The state of healthcare quality measurement in the era of COVID-19: the importance of doing better. JAMA 2020;324:333–334.CrossRefGoogle ScholarPubMed
Hospital Readmissions Reduction Program (HRRP). Center for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program. Accessed May 29, 2022.Google Scholar
Horwitz, L, Partovian, C, Lin, Z, et al. Hospital-wide (all-condition) 30-day risk-standardized readmission measure. Center for Medicare and Medicaid Services website. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/mms/downloads/mmshospital-wideall-conditionreadmissionrate.pdf. Accessed August 9, 2022.Google Scholar
2016 measure information about the 30-day all-cause hospital readmission measure, calculated for the 2018 value-based payment modifier program. Center for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-ACR-MIF.pdf. Published online 2017. Accessed May 29, 2022.Google Scholar
Continued increases in the incidence of healthcare-associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022. doi: 10.1017/ice.2022.116.Google Scholar
Grimm, CA. Hospitals reported that the COVID-19 pandemic has significantly strained healthcare delivery. Department of Health and Human Services Offices of the Inspector General website. https://oig.hhs.gov/oei/reports/OEI-09-21-00140.pdf. Published 2021. Accessed May 29, 2022.Google Scholar
Lavery, AM, Preston, LE, Ko, JY, et al. Characteristics of hospitalized COVID-19 patients discharged and experiencing same-hospital readmission—United States, March–August 2020. Morb Mortal Wkly Rep 2020;69:1695–1699.CrossRefGoogle ScholarPubMed
Taupin, D, Anderson, TS, Merchant, EA, et al. Preventability of 30-day hospital revisits following admission with COVID-19 at an academic medical center. Jt Comm J Qual Patient Saf 2021;47:696–703.Google ScholarPubMed
Japaridze, M, Amzat, T, Iheaku, O, et al. Risk factors for 30-days readmission of patients with covid19 infection: a retrospective-prospective study from the Cross Collaborative. Journal of Hospital Medicine website. https://shmabstracts.org/abstract/risk-factors-for-30-days-readmission-of-patients-with-covid19-infection-a-retrospective-prospective-study-from-the-cross-collaborative/. Accessed May 29, 2022.Google Scholar
Chopra, V, Flanders, SA, O’Malley, M, Malani, AN, Prescott, HC. Sixty-day outcomes among patients hospitalized with COVID-19. Ann Intern Med 2021;174:576–578.CrossRefGoogle ScholarPubMed
Atalla, E, Kalligeros, M, Giampaolo, G, Mylona, EK, Shehadeh, F, Mylonakis, E. Readmissions among patients with COVID-19. Int J Clin Pract 2021;75:e13700.CrossRefGoogle ScholarPubMed
Donnelly, JP, Wang, XQ, Iwashyna, TJ, Prescott, HC. Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA 2021;325:304–306.CrossRefGoogle Scholar
Ramzi, ZS. Hospital readmissions and postdischarge all-cause mortality in COVID-19 recovered patients: a systematic review and meta-analysis. Am J Emerg Med 2022;51:267–279.CrossRefGoogle ScholarPubMed
Verna, EC, Landis, C, Brown, RS, et al. Factors associated with readmission in the United States following hospitalization with coronavirus disease 2019. Clin Infect Dis 2022;74:1713–1721.CrossRefGoogle ScholarPubMed
Mozaffari, E, Liang, S, Stewart, HM, Thrun, M, Hodgkins, P, Haubrich, R. COVID-19 hospitalization and 30-day readmission: a cohort study of US hospitals. Open Forum Infect Dis 2021;8 suppl 1:S332.CrossRefGoogle Scholar
Richardson, S, Hirsch, JS, Narasimhan, M, et al. Presenting characteristics, comorbidities, and outcomes among 5,700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052–2059. Erratum in: JAMA 2020;323:2098.CrossRefGoogle Scholar
Yeo, I, Baek, S, Kim, J, et al. Assessment of thirty-day readmission rate, timing, causes and predictors after hospitalization with COVID-19. J Intern Med 2021;290:157–165.CrossRefGoogle ScholarPubMed
Premier Healthcare Database White Paper. Premier Products website. https://products.premierinc.com/downloads/PremierHealthcareDatabaseWhitepaper.pdf. Accessed May 29, 2022.Google Scholar
Pineles, BL, Goodman, KE, Pineles, L, et al. In-hospital mortality in a cohort of hospitalized pregnant and nonpregnant patients with COVID-19. Ann Intern Med 2021;174:1186–1188.CrossRefGoogle Scholar
Pennington, AF, Kompaniyets, L, Summers, AD, et al. Risk of clinical severity by age and race/ethnicity among adults hospitalized for COVID-19—United States, March–September 2020. Open Forum Infect Dis 2021:ofaa638.CrossRefGoogle Scholar
Kadri, SS, Demirkale, CY, Sun, J, et al. Real-world inpatient use of medications repurposed for coronavirus disease 2019 in United States hospitals, March–May 2020. Open Forum Infect Dis 2020;8:ofaa616.CrossRefGoogle ScholarPubMed
Baghdadi, JD, Coffey, KC, Adediran, T, et al. Antibiotic use and bacterial infection among inpatients in the first wave of COVID-19: a retrospective cohort study of 64,691 patients. Antimicrob Agents Chemother 2021;65:e0134121.CrossRefGoogle ScholarPubMed
Goodman, KE, Magder, LS, Baghdadi, JD, et al. Impact of sex and metabolic comorbidities on coronavirus disease 2019 (COVID-19) mortality risk across age groups: 66,646 inpatients across 613 US hospitals. Clin Infect Dis 2021;73:e4113–e4123.CrossRefGoogle Scholar
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573–577.CrossRefGoogle ScholarPubMed
COVID-19 guidelines. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf. Published 2020. Accessed May 29, 2022.Google Scholar
Kadri, SS, Gundrum, J, Warner, S, et al. Uptake and accuracy of the diagnosis code for COVID-19 among US hospitalizations. JAMA 2020;324:2553–2554.CrossRefGoogle ScholarPubMed
Elixhauser comorbidity software refined for ICD-10-CM. Healthcare Cost and Utilization Project website. https://www.hcup-us.ahrq.gov/toolssoftware/comorbidityicd10/comorbidity_icd10.jsp. Accessed May 29, 2022.Google Scholar
Bhatt, AS, Jering, KS, Vaduganathan, M, et al. Clinical outcomes in patients with heart failure hospitalized with COVID-19. Jacc Heart Fail 2021;9:65–73.CrossRefGoogle ScholarPubMed
Wu, Z, McGoogan, JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239–1242.CrossRefGoogle Scholar
Kompaniyets, L, Goodman, AB, Belay, B, et al. Body mass index and risk for COVID-19–related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death—United States, March–December 2020. Morb Mortal Wkly Rep 2021;70:355–361.CrossRefGoogle Scholar
Clinical classifications software refined (CCSR) for ICD-10-CM diagnoses. Healthcare Cost and Utilization Project website. https://www.hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp. Accessed May 29, 2022.Google Scholar
Schreiber-Gregory, DN, Jackson, HM. Multicollinearity: what is it, why should we care, and how can it be controlled? SAS website. https://support.sas.com/resources/papers/proceedings17/1404-2017.pdf. Published 2017. Accessed September 13, 2022.Google Scholar
Evaluating discrimination of risk prediction models: the C statistic. JAMA Guide to Statistics and Methods website. https://jamaevidence.mhmedical.com/content.aspx?bookid=2742&sectionid=233568253. Accessed May 30, 2022.Google Scholar
Masroor, S. Collateral damage of COVID-19 pandemic: delayed medical care. J Card Surg 2020;35:1345–1347.CrossRefGoogle ScholarPubMed
Biscarini, S, Colaneri, M, Ludovisi, S, et al. The obesity paradox: analysis from the Smatteo COVID-19 Registry (SMACORE) cohort. Nutr Metab Cardiovasc Dis 2020;30:1920–1925.CrossRefGoogle ScholarPubMed
Yandrapalli, S, Aronow, WS, Frishman, WH. Readmissions in adult patients following hospitalization for influenza: a nationwide cohort study. Ann Transl Med 2018;6:318–318.CrossRefGoogle ScholarPubMed
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