Swiss COVID-19 hospital surveillance: an in-depth analysis of the factors associated with hospital readmission dynamics in community-acquired COVID-19 cases (original) (raw)

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Original article

Vol. 154 No. 9 (2024)

Summary

BACKGROUND: The COVID-19 pandemic has placed unprecedented pressure on hospitals worldwide. In such a context of tension in healthcare systems, efficiently allocating hospital resources is a crucial aspect of crisis management. The aim of this study was to describe the clinical characteristics of readmitted patients and to determine risk factors for hospital readmission using data from the Swiss COVID-19 Hospital-Based Surveillance system (CH-SUR).

METHODS: We investigated hospital readmissions within 60 days after discharge of patients from the CH-SUR surveillance system with a first hospitalisation between 1 December 2020 and 1 December 2021. Only community-acquired cases were considered. We compared the baseline characteristics of readmitted and non-readmitted patients. We performed univariable and multivariable logistic regression analyses to investigate the risk factors for hospital readmission.

FINDINGS: Of the 8039 eligible patients, 239 (3.0%, 95% confidence interval [CI] 2.6–3.3%) were readmitted to hospital within 60 days of discharge, with no significant variations observed over the study period; 80% of all readmissions occurred within 10 days of discharge of the index hospital stay. Based on our multivariable logistic regression models, factors increasing the odds of hospital readmission were age ≥65 years (odds ratio [OR] 1.63, 95% CI 1.24–2.15), male sex (OR 1.47, 95% CI 1.12–1.93), being discharged to home after first hospitalisation (OR 1.77, 95% CI 1.19–2.62), having oncological pathology (OR 1.82, 95% CI 1.27–2.61) and being immunosuppressed (OR 2.34, 95% CI 1.67–3.29).

INTERPRETATIONS: Age, sex, cardiovascular diseases, oncological pathologies and immunosuppression were the main risk factors identified for hospital readmission.

References

  1. COVID-19 Hospitalizations. Available at: https://gis.cdc.gov/grasp/covidnet/covid19_3.html. Accessed 30 May 2022.
  2. OFSP O fédéral de la santé publique. Coronavirus: monitorage. Available at: https://www.bag.admin.ch/bag/fr/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international/monitoring.html. Accessed 10 June 2022.
  3. Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, et al. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2013 Jun;61(6):605–611.e6. [cited 2022 Jun 22] Available from: https://linkinghub.elsevier.com/retrieve/pii/S019606441201699X doi: https://doi.org/10.1016/j.annemergmed.2012.10.026DOI: https://doi.org/10.1016/j.annemergmed.2012.10.026
  4. Coffey LW. Savage, et al. Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review. International Journal of Environmental Research and Public Health 2019; 16:2457. Available at: https://www.mdpi.com/1660-4601/16/14/2457. Accessed 22 June 2022. DOI: https://doi.org/10.3390/ijerph16142457
  5. Felix HC, Seaberg B, Bursac Z, Thostenson J, Stewart MK. Why do patients keep coming back? Results of a readmitted patient survey. Soc Work Health Care. 2015;54(1):1–15. [cited 2022 May 30] 10.1080/00981389.2014.966881 DOI: https://doi.org/10.1080/00981389.2014.966881
  6. Leijte WT, Wagemaker NM, van Kraaij TD, de Kruif MD, Mostard GJ, Leers MP, et al. [Mortality and re-admission after hospitalization with COVID-19]. Ned Tijdschr Geneeskd. 2020 Nov;164:D5423.
  7. Wang X, Zhou Y, Jiang N, Zhou Q, Ma WL. Persistence of intestinal SARS-CoV-2 infection in patients with COVID-19 leads to re-admission after pneumonia resolved. Int J Infect Dis. 2020 Jun;95:433–5. [cited 2022 Jun 22] Available from: https://linkinghub.elsevier.com/retrieve/pii/S1201971220302794 doi: https://doi.org/10.1016/j.ijid.2020.04.063DOI: https://doi.org/10.1016/j.ijid.2020.04.063
  8. UyaroĞlu OA, BaŞaran NÇ, ÖziŞik L, Dİzman GT, EroĞlu İ, Şahİn TK, et al. Thirty-day readmission rate of COVID-19 patients discharged from a tertiary care university hospital in Turkey: an observational, single-center study. Int J Qual Health Care. 2021 Feb;33(1):mzaa144. [cited 2022 Jun 22] Available from: https://academic.oup.com/intqhc/article/doi/10.1093/intqhc/mzaa144/5940459 10.1093/intqhc/mzaa144 DOI: https://doi.org/10.1093/intqhc/mzaa144
  9. Yeo I, Baek S, Kim J, Elshakh H, Voronina A, Lou MS, et al. Assessment of thirty-day readmission rate, timing, causes and predictors after hospitalization with COVID-19. J Intern Med. 2021 Jul;290(1):157–65. [cited 2022 Jun 22] Available from: https://onlinelibrary.wiley.com/doi/10.1111/joim.13241 10.1111/joim.13241 DOI: https://doi.org/10.1111/joim.13241
  10. Banerjee J, Canamar CP, Voyageur C, Tangpraphaphorn S, Lemus A, Coffey C Jr, et al. Mortality and Readmission Rates Among Patients With COVID-19 After Discharge From Acute Care Setting With Supplemental Oxygen. JAMA Netw Open. 2021 Apr;4(4):e213990. [cited 2022 Jun 22] Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778078 doi: https://doi.org/10.1001/jamanetworkopen.2021.3990DOI: https://doi.org/10.1001/jamanetworkopen.2021.3990
  11. Yang Z, Chen X, Huang R, Li S, Lin D, Yang Z, et al. Atypical presentations of coronavirus disease 2019 (COVID-19) from onset to readmission. BMC Infect Dis. 2021 Jan;21(1):127. [cited 2022 Jun 22] Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05751-8 10.1186/s12879-020-05751-8 DOI: https://doi.org/10.1186/s12879-020-05751-8
  12. Chaudhry Z, Shawe-Taylor M, Rampling T, Cutfield T, Bidwell G, Chan XH, et al. Short durations of corticosteroids for hospitalised COVID-19 patients are associated with a high readmission rate. J Infect. 2021 Jun;82(6):276–316. [cited 2022 Jun 22] Available from: https://linkinghub.elsevier.com/retrieve/pii/S0163445321001158 doi: https://doi.org/10.1016/j.jinf.2021.03.002DOI: https://doi.org/10.1016/j.jinf.2021.03.002
  13. Lavery AM, Preston LE, Ko JY, Chevinsky JR, DeSisto CL, Pennington AF, et al. Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission - United States, March-August 2020. MMWR Morb Mortal Wkly Rep. 2020 Nov;69(45):1695–9. [cited 2022 Jun 22] Available from: http://www.cdc.gov/mmwr/volumes/69/wr/mm6945e2.htm?s_cid=mm6945e2_w doi: https://doi.org/10.15585/mmwr.mm6945e2DOI: https://doi.org/10.15585/mmwr.mm6945e2
  14. Jeon WH, Seon JY, Park SY, Oh IH. Analysis of Risk Factors on Readmission Cases of COVID-19 in the Republic of Korea: Using Nationwide Health Claims Data. Int J Environ Res Public Health. 2020 Aug;17(16):5844. [cited 2022 Jun 22] Available from: https://www.mdpi.com/1660-4601/17/16/5844 doi: https://doi.org/10.3390/ijerph17165844DOI: https://doi.org/10.3390/ijerph17165844
  15. Ye S, Hiura G, Fleck E, Garcia A, Geleris J, Lee P, et al. Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness. J Gen Intern Med. 2021 Mar;36(3):722–9. [cited 2022 Jun 22] Available from: https://link.springer.com/10.1007/s11606-020-06340-w 10.1007/s11606-020-06340-w DOI: https://doi.org/10.1007/s11606-020-06340-w
  16. Thiabaud A, Iten A, Balmelli C, Senn L, Troillet N, Widmer A, et al. Cohort profile: SARS-CoV-2/COVID-19 hospitalised patients in Switzerland. Swiss Med Wkly. 2021 Feb;151(708):w20475. [cited 2022 Jun 22] Available from: https://doi.emh.ch/smw.2021.20475 doi: https://doi.org/10.4414/smw.2021.20475DOI: https://doi.org/10.4414/smw.2021.20475
  17. Hospital-based surveillance of COVID-19 in Switzerland. 2020; Available at: https://www.unige.ch/medecine/hospital-covid/. Accessed 30 April 2021.
  18. Maximiano Sousa F, Roelens M, Fricker B, Thiabaud A, Iten A, Cusini A, et al.; Ch-Sur Study Group. Risk factors for severe outcomes for COVID-19 patients hospitalised in Switzerland during the first pandemic wave, February to August 2020: prospective observational cohort study. Swiss Med Wkly. 2021 Jul;151(2930):w20547. [cited 2021 Sep 27] Available from: https://smw.ch/article/doi/smw.2021.20547 doi: https://doi.org/10.4414/smw.2021.20547DOI: https://doi.org/10.4414/smw.2021.20547
  19. Putter H, Fiocco M, Geskus RB. Tutorial in biostatistics: competing risks and multi-state models. Stat Med. 2007 May;26(11):2389–430. [cited 2022 Jun 22] Available from: https://onlinelibrary.wiley.com/doi/10.1002/sim.2712 10.1002/sim.2712 DOI: https://doi.org/10.1002/sim.2712
  20. van Buuren S, Groothuis-Oudshoorn K. Mice : Multivariate Imputation by Chained Equations in r. J Stat Softw. 2011;45(3):1–67. [cited 2022 Jun 22] Available from: http://www.jstatsoft.org/v45/i03/ doi: https://doi.org/10.18637/jss.v045.i03DOI: https://doi.org/10.18637/jss.v045.i03
  21. Parra LM, Cantero M, Morrás I, Vallejo A, Diego I, Jiménez-Tejero E, et al.; Puerta de Hierro Hospital Admission Study Group. Hospital Readmissions of Discharged Patients with COVID-19. Int J Gen Med. 2020 Dec;13:1359–66. [cited 2022 Jun 22] Available from: https://www.dovepress.com/hospital-readmissions-of-discharged-patients-with-covid-19-peer-reviewed-article-IJGM doi: https://doi.org/10.2147/IJGM.S275775DOI: https://doi.org/10.2147/IJGM.S275775
  22. Somani SS, Richter F, Fuster V, De Freitas JK, Naik N, Sigel K, et al.; Mount Sinai COVID Informatics Center. Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19. J Gen Intern Med. 2020 Oct;35(10):2838–44. [cited 2022 Jun 22] Available from: https://link.springer.com/10.1007/s11606-020-06120-6 10.1007/s11606-020-06120-6 DOI: https://doi.org/10.1007/s11606-020-06120-6
  23. Li XJ, Zhang ZW, Zong ZY. A case of a readmitted patient who recovered from COVID-19 in Chengdu, China. Crit Care. 2020 Apr;24(1):152. [cited 2022 May 30] 10.1186/s13054-020-02877-8 DOI: https://doi.org/10.1186/s13054-020-02877-8
  24. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al.; the Northwell COVID-19 Research Consortium. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 May;323(20):2052–9. [cited 2022 May 30] 10.1001/jama.2020.6775 DOI: https://doi.org/10.1001/jama.2020.6775
  25. Wang H, Li Y, Wang F, Du H, Lu X. Rehospitalization of a Recovered Coronavirus Disease 19 (COVID-19) Child With Positive Nucleic Acid Detection. Pediatr Infect Dis J. 2020 Jun;39(6):e69–70. [cited 2022 May 30] Available from: https://journals.lww.com/pidj/Fulltext/2020/06000/Rehospitalization_of_a_Recovered_Coronavirus.21.aspx doi: https://doi.org/10.1097/INF.0000000000002690DOI: https://doi.org/10.1097/INF.0000000000002690
  26. Loo WK, Hasikin K, Suhaimi A, Yee PL, Teo K, Xia K, et al. Systematic Review on COVID-19 Readmission and Risk Factors: Future of Machine Learning in COVID-19 Readmission Studies. Front Public Health. 2022 May;10:898254. [cited 2022 Jun 22] Available from: https://www.frontiersin.org/articles/10.3389/fpubh.2022.898254/full 10.3389/fpubh.2022.898254 DOI: https://doi.org/10.3389/fpubh.2022.898254
  27. Siemieniuk RA, Bartoszko JJ, Zeraatkar D, Kum E, Qasim A, Martinez JP, et al. Drug treatments for covid-19: living systematic review and network meta-analysis. BMJ. 2020 Jul;370:m2980. [cited 2022 Jul 27] Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.m2980 10.1136/bmj.m2980
  28. Ramos-Martínez A, Parra-Ramírez LM, Morrás I, Carnevali M, Jiménez-Ibañez L, Rubio-Rivas M, et al. Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients. Sci Rep. 2021 Jul;11(1):13733. [cited 2022 Jun 22] Available from: http://www.nature.com/articles/s41598-021-93076-0 doi: https://doi.org/10.1038/s41598-021-93076-0DOI: https://doi.org/10.1038/s41598-021-93076-0
  29. Takahashi T, Ellingson MK, Wong P, Israelow B, Lucas C, Klein J, et al.; Yale IMPACT Research Team. Sex differences in immune responses that underlie COVID-19 disease outcomes. Nature. 2020 Dec;588(7837):315–20. [cited 2022 Jun 22] Available from: https://www.nature.com/articles/s41586-020-2700-3 doi: https://doi.org/10.1038/s41586-020-2700-3DOI: https://doi.org/10.1038/s41586-020-2700-3
  30. Walter LA, McGregor AJ. Sex- and Gender-specific Observations and Implications for COVID-19. West J Emerg Med. 2020 Apr;21(3):507–9. [cited 2022 Jun 22] Available from: https://escholarship.org/uc/item/76f9p924 doi: https://doi.org/10.5811/westjem.2020.4.47536DOI: https://doi.org/10.5811/westjem.2020.4.47536
  31. Verna EC, Landis C, Brown RS Jr, et al. Factors Associated with Readmission in the US Following Hospitalization with COVID-19. 2021; ciab464. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240865/. Accessed 31 March 2022.
  32. Atalla E, Kalligeros M, Giampaolo G, Mylona EK, Shehadeh F, Mylonakis E. Readmissions among patients with COVID-19. Int J Clin Pract. 2021 Mar;75(3):e13700. [cited 2022 Jun 22] Available from: https://onlinelibrary.wiley.com/doi/10.1111/ijcp.13700 10.1111/ijcp.13700 DOI: https://doi.org/10.1111/ijcp.13700
  33. Townsend L, Dowds J, O’Brien K, Sheill G, Dyer AH, O’Kelly B, et al. Persistent Poor Health after COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity. Ann Am Thorac Soc. 2021 Jun;18(6):997–1003. [cited 2022 Jun 22] Available from: https://www.atsjournals.org/doi/10.1513/AnnalsATS.202009-1175OC 10.1513/AnnalsATS.202009-1175OC DOI: https://doi.org/10.1513/AnnalsATS.202009-1175OC
  34. Subramaniam A, Lim ZJ, Ponnapa Reddy M, Shekar K. Systematic review and meta-analysis of the characteristics and outcomes of readmitted COVID-19 survivors. Intern Med J. 2021 Nov;51(11):1773–80. [cited 2022 Jun 22] Available from: https://onlinelibrary.wiley.com/doi/10.1111/imj.15350 10.1111/imj.15350 DOI: https://doi.org/10.1111/imj.15350
  35. Xiao AT, Tong YX, Zhang S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: rather than recurrence. J Med Virol. 2020 Oct;92(10):1755–6. [cited 2022 Jun 22] Available from: https://onlinelibrary.wiley.com/doi/10.1002/jmv.25855 10.1002/jmv.25855 DOI: https://doi.org/10.1002/jmv.25855
  36. Huang CW, Desai PP, Wei KK, Liu IA, Lee JS, Nguyen HQ. Characteristics of patients discharged and readmitted after COVID-19 hospitalisation within a large integrated health system in the United States. Infect Dis (Lond). 2021 Oct;53(10):800–4. [cited 2022 Jun 22] Available from: https://www.tandfonline.com/doi/full/10.1080/23744235.2021.1924398 10.1080/23744235.2021.1924398 DOI: https://doi.org/10.1080/23744235.2021.1924398
  37. Krumholz HM, Wang K, Lin Z, Dharmarajan K, Horwitz LI, Ross JS, et al. Hospital-Readmission Risk - Isolating Hospital Effects from Patient Effects. N Engl J Med. 2017 Sep;377(11):1055–64. [cited 2022 Jun 22] Available from: http://www.nejm.org/doi/10.1056/NEJMsa1702321 10.1056/NEJMsa1702321 DOI: https://doi.org/10.1056/NEJMsa1702321
  38. Okma KG, Cheng T, Chinitz D, Crivelli L, Lim M, Maarse H, et al. Six Countries, Six Health Reform Models? Health Care Reform in Chile, Israel, Singapore, Switzerland, Taiwan and The Netherlands. J Comp Policy Anal. 2010;12(1-2):75–113. [cited 2022 Jun 22] Available from: http://www.tandfonline.com/doi/abs/10.1080/13876980903076237 10.1080/13876980903076237 DOI: https://doi.org/10.1080/13876980903076237
  39. WHO. Switzerland: Health system review. Available at: https://apps.who.int/iris/handle/10665/330252. Accessed 10 June 2022.
  40. Stuart M, Ryser C, Levitt A, Beer S, Kesselring J, Chard S, et al. Stroke rehabilitation in Switzerland versus the United States: a preliminary comparison. Neurorehabil Neural Repair. 2005 Jun;19(2):139–47. [cited 2022 Jun 22] Available from: http://journals.sagepub.com/doi/10.1177/1545968305277088 10.1177/1545968305277088 DOI: https://doi.org/10.1177/1545968305277088
  41. Akbari A, Fathabadi A, Razmi M, Zarifian A, Amiri M, Ghodsi A, et al. Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis. Am J Emerg Med. 2022 Feb;52:166–73. [cited 2022 Jun 22] Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675721009827 doi: https://doi.org/10.1016/j.ajem.2021.12.012DOI: https://doi.org/10.1016/j.ajem.2021.12.012
  42. Nematshahi M, Soroosh D, Neamatshahi M, Attarian F, Rahimi F. Factors predicting readmission in patients with COVID-19. BMC Res Notes. 2021 Sep;14(1):374. [cited 2022 Jun 22] Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-021-05782-7 10.1186/s13104-021-05782-7 DOI: https://doi.org/10.1186/s13104-021-05782-7
  43. McAlister FA, MMath YD, MHSc AC, et al. The risk of death or unplanned readmission after discharge from a COVID-19 hospitalization in Alberta and Ontario. 2022; 194:8. DOI: https://doi.org/10.1503/cmaj.220272

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