Scientific Publications Database

Article Title: The risk of death or unplanned readmission after discharge from a COVID-19 hospitalization in Alberta and Ontario
Authors: McAlister, Finlay A.; Dong, Yuan; Chu, Anna; Wang, Xuesong; Youngson, Erik; Quinn, Kieran L.; Verma, Amol; Udell, Jacob A.; Yu, Amy Y. X.; Razak, Fahad; Ho, Chester; de Mestral, Charles; Ross, Heather J.; van Walraven, Carl; Lee, Douglas S.
Date of Publication:2022
Background: The frequency of readmissions after COVID-19 hospitalizations is uncertain, as is whether current readmission prediction equations are useful for discharge risk stratification of COVID-19 survivors or for comparing among hospitals. We sought to determine the frequency and predictors of death or unplanned readmission after a COVID-19 hospital discharge.Methods: We conducted a retrospective cohort study of all adults (>= 18 yr) who were discharged alive from hospital after a nonpsychiatric, nonobstetric, acute care admission for COVID-19 between Jan. 1, 2020, and Sept. 30, 2021, in Alberta and Ontario.Results: Of 843 737 individuals who tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction during the study period, 46412 (5.5%) were adults admitted to hospital within 14 days of their positive test. Of these, 8496 died in hospital and 34846 were discharged alive (30336 discharged after an index admission of <= 30 d and 4510 discharged after an admission > 30 d). One in 9 discharged patients died or were readmitted within 30 days after discharge (3173 [10.5%] of those with stay <= 30 d and 579 [12.8%] of those with stay > 30 d). The LACE score (length of stay, acuity, Charlson Comorbidity Index and number of emergency visits in previous 6 months) for predicting urgent readmission or death within 30 days had a c-statistic of 0.60 in Alberta and 0.61 in Ontario; inclusion of sex, discharge locale, deprivation index and teaching hospital status in the model improved the c-statistic to 0.73.Interpretation: Death or readmission after discharge from a COVID-19 hospitalization is common and had a similar frequency in Alberta and Ontario. Risk stratification and interinstitutional comparisons of outcomes after hospital admission for COVID-19 should include sex, discharge locale and socioeconomic measures, in addition to the LACE variables.