Post COVID-19 care: Risk of readmission and death highest in first ten days after hospital discharge, says study
Observing that there was limited data on the initial outcomes after hospitalisation, researchers set out to measure the rate of readmission, reasons for readmission and rate of death after hospital discharge among the patients with COVID-19
Even as the COVID-19 pandemic continues to rage on, the death rates due to this disease have decreased in many parts of the world. And yet, many patients who are recovering from COVID-19 tend to have some complications, even if they had mild disease.
The concept of long COVID is quickly gaining popularity because not only do patients tend to have prolonged or persistent symptoms even after getting two consecutive negative COVID-19 test results but also because rehospitalisations and deaths due to post-COVID complications continue to occur.
A new study published in JAMA suggests that the highest risk to a COVID-19 patient’s health is likely to be in the 10-day period after discharge from the hospital, and so, proper care and monitoring the health status of patients is very important during this early stage of recovery.
Peak of post-COVID morbidity and mortality risks
The study was conducted by researchers based at the University of Michigan and Veteran Affairs Ann Arbor Healthcare System. Observing that there was limited data on the initial outcomes after hospitalisation, the researchers set out to measure the rate of readmission, reasons for readmission and rate of death after hospital discharge among the patients with COVID-19 .
To do this, they used a two-pronged approach:
First, they collected data on the hospitalisation of veterans with COVID-19 from 132 VA hospitals. The patients admitted between March and June 2020 and discharged between March and July 2020 were included in this study.
Second, they identified veterans hospitalised during the same durations due to non-COVID related pneumonia and heart failure. The researchers focused on data regarding length of hospitalisation, use of an intensive care unit (ICU), dependence on invasive mechanical ventilation and need of vasopressors (drugs used to treat very low blood pressure).
They then measured the readmission and death risks up to 60 days after discharge among COVID-19 survivors and also calculated the hazard ratios of readmission for 10, 20, 20-40 and 40-60 days after discharge.
Common reasons for readmission and death
The researchers collected data regarding 2,179 veteran hospitalisations for COVID-19 , of which 678 patients were treated in the ICU, 279 had to access mechanical ventilators, 307 received vasopressors and 1,775 survived the disease to be finally discharged. Among these survivors, 354 (19.9 percent) were readmitted, 162 (9.1 percent) died and 479 (27 percent) were observed to have been readmitted or died within 60 days of being discharged.
The most common reasons for readmission and death of survivors were COVID-19 reinfection, sepsis, pneumonia and heart failure. During readmission, 22.6 percent of these patients had to be treated in ICUs, 7.1 percent were mechanically ventilated and 7.9 percent received vasopressors.
In the other cohort of veterans with non-COVID hospitalisations, 2,156 patients had pneumonia and 4,269 had heart failure, of which 97.8 percent and 98.3 percent survived, respectively, and were discharged after treatment. After excluding patients who died, the health outcomes of 1,799 patients with pneumonia and 3,505 with heart failure were compared to those who survived COVID-19 and were discharged.
On comparing these two cohorts of surviving patients, the researchers found that COVID-19 survivors had lower rates of 60-day readmission or death compared to patients with pneumonia or heart failure. However, COVID-19 survivors had the highest rates of readmission and/or death within the first 10 days after discharge compared to these same patients.
Urgent need for critical care in first 10 days after discharge
Even though the prognosis for COVID-19 survivors after discharge for the duration of 60 days doesn’t seem that bad when compared to patients of other potentially fatal causes of admission, the findings regarding the rates of readmission or death in the first 10 days suggest a heightened risk of clinical deterioration during this period.
The researchers thus conclude that even though their study has some limitations (both cohorts were predominantly male and aged, and therefore had higher risks of severe outcomes) public health surveillance and clinical care for the period of 10 days after discharge for all COVID-19 patients is crucial.
If the healthcare systems and clinical trials for drugs, vaccines, etc focus just on mortality during hospitalisations and do not take this critical period post-hospitalisation into account then they may be underestimating the burden of COVID-19 and getting skewed results to the detriment of the entire global population battling the pandemic.
For more information, read our article on Post-COVID care.
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