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1.
J Med Virol ; 94(1): 44-53, 2022 01.
Article in English | MEDLINE | ID: covidwho-1544334

ABSTRACT

Recent studies reported that some recovered COVID-19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID-19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long-term immunity after SARS-Cov-2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID-19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled.


Subject(s)
COVID-19/epidemiology , Patient Readmission/statistics & numerical data , Reinfection/epidemiology , SARS-CoV-2/isolation & purification , COVID-19 Vaccines/immunology , Female , Humans , Male , Recurrence , SARS-CoV-2/immunology , Sex Factors , Sex Ratio , Vaccination
2.
N Engl J Med ; 385(15): 1355-1371, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1397961

ABSTRACT

BACKGROUND: There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS: We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS: The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS: Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 Vaccines , COVID-19/prevention & control , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Vaccines/immunology , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Patient Readmission/statistics & numerical data , United States/epidemiology
3.
Sci Rep ; 11(1): 17416, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1380910

ABSTRACT

Burden of COVID-19 on Hospitals across the globe is enormous and has clinical and economic implications. In this retrospective study including consecutive adult patients with confirmed SARS-CoV-2 who were admitted between 3/2020 and 30/9/20, we aimed to identify post-discharge outcomes and risk factors for re-admission among COVID-19 hospitalized patients. Mortality and re-admissions were documented for a median post discharge follow up of 59 days (interquartile range 28,161). Univariate and multivariate analyses of risk factors for re-admission were performed. Overall, 618 hospitalized COVID-19 patients were included. Of the 544 patient who were discharged, 10 patients (1.83%) died following discharge and 50 patients (9.2%) were re-admitted. Median time to re-admission was 7 days (interquartile range 3, 24). Oxygen saturation or treatment prior to discharge were not associated with re-admissions. Risk factors for re-admission in multivariate analysis included solid organ transplantation (hazard ratio [HR] 3.37, 95% confidence interval [CI] 2.73-7.5, p = 0.0028) and higher Charlson comorbidity index (HR 1.34, 95% CI 1.23-1.46, p < 0.0001). Mean age of post discharge mortality cases was 85.0 (SD 9.98), 80% of them had cognitive decline or needed help in ADL at baseline. In conclusion, re-admission rates of hospitalized COVID-19 are fairly moderate. Predictors of re-admission are non-modifiable, including baseline comorbidities, rather than COVID-19 severity or treatment.


Subject(s)
Activities of Daily Living/psychology , COVID-19/mortality , Cognitive Dysfunction/epidemiology , Patient Readmission/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/psychology , Cognitive Dysfunction/psychology , Female , Humans , Male , Middle Aged , Mortality , Multivariate Analysis , Retrospective Studies , Risk Factors , Time Factors , Young Adult
4.
PLoS One ; 16(8): e0255427, 2021.
Article in English | MEDLINE | ID: covidwho-1344154

ABSTRACT

BACKGROUND: COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment. AIM: The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission. METHODS: An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort. RESULTS: Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%. CONCLUSIONS: The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Patient Readmission/trends , Adult , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Female , Germany/epidemiology , Hospital Mortality/trends , Hospitalization/trends , Humans , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Patient Discharge/trends , Patient Readmission/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2/pathogenicity , Time Factors
5.
World Neurosurg ; 154: e118-e129, 2021 10.
Article in English | MEDLINE | ID: covidwho-1337002

ABSTRACT

OBJECTIVE: Neurosurgical patients are at a higher risk of having a severe course of coronavirus disease 2019 (COVID-19). The objective of this study was to determine morbidity, hospital course, and mortality of neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic in a multicenter health care system. METHODS: A retrospective observational study was conducted to identify all hospitalized neurosurgical patients positive for COVID-19 from March 11, 2020 to November 2, 2020 at Mayo Clinic and the Mayo Clinic Health System. RESULTS: Eleven hospitalized neurosurgical patients (0.68%) were positive for COVID-19. Four patients (36.6%) were men and 7 (63.3%) were women. The mean age was 65.7 years (range, 35-81 years). All patients had comorbidities. The mean length of stay was 13.4 days (range, 4-30 days). Seven patients had a central nervous system malignancy (4 metastases, 1 meningioma, 1 glioblastoma, and 1 schwannoma). Three patients presented with cerebrovascular complications, comprising 2 spontaneous intraparenchymal hemorrhages and 1 ischemic large-vessel stroke. One patient presented with an unstable traumatic spinal burst fracture. Four patients underwent neurosurgical/neuroendovascular interventions. Discharge disposition was to home in 5 patients, rehabilitation facility in 3, and hospice in 3. Five patients had died at follow-up, 3 within 30 days from COVID-19 complications and 2 from progression of their metastatic cancer. CONCLUSIONS: COVID-19 is rare among the inpatient neurosurgical population. In all cases, patients had multiple comorbidities. All symptomatic patients from the respiratory standpoint had complications during their hospitalization. Deaths of 3 patients who died within 30 days of hospitalization were all related to COVID-19 complications. Neurosurgical procedures were performed only if deemed emergent.


Subject(s)
COVID-19/complications , Neurosurgical Procedures/methods , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Central Nervous System Neoplasms/surgery , Cerebrovascular Disorders/complications , Comorbidity , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Neurosurgical Procedures/mortality , Pandemics , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Retrospective Studies , Spinal Fractures/surgery , Treatment Outcome
6.
J Korean Med Sci ; 36(27): e196, 2021 Jul 12.
Article in English | MEDLINE | ID: covidwho-1308263

ABSTRACT

BACKGROUND: This is an observational study to analyze an emergency department (ED) utilization pattern of coronavirus disease 2019 (COVID-19) vaccinated in-hospital healthcare workers (HCWs). METHODS: We included 4,703 HCWs who were administered the first dose of the COVID-19 vaccine between March 4 and April 2, 2021, in a tertiary hospital in Korea where fast-track and post-vaccination cohort zone (PVCZ) were introduced in ED. We analyzed data of participants' age, sex, occupation, date and type of vaccination, and their clinical information using SPSS v25.0. RESULTS: The sample comprised HCWs, who received either the ChAdOx1 (n = 4,458) or the BNT162B2 (n = 245) vaccines; most participants were female (73.5%), and 81.1% were under 50 years old. Further, 153 (3.3%) visited the ED and reported experiencing fever (66.9%) and myalgia (56.1%). Additionally, 91 (59.5%) of them were in their 20s, and 106 (67.5%) were assigned to the PVCZ. Lastly, 107 (68.2%) of the patients received parenteral management. No patient required hospitalization. CONCLUSION: In conclusion, vaccinated HCWs who visited the ED with adverse events had a high incidence of fever and a low likelihood of developing serious illnesses. As the COVID-19 vaccination program for Korean citizens continues to expand, strategies to minimize unnecessary ED overcrowding should be put into effect.


Subject(s)
COVID-19 Vaccines/adverse effects , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Personnel, Hospital/statistics & numerical data , Vaccination/adverse effects , Adult , Antiemetics/therapeutic use , Antipyretics/therapeutic use , COVID-19 Testing/statistics & numerical data , Chills/chemically induced , Chills/epidemiology , Clinical Protocols , Emergency Service, Hospital/organization & administration , Female , Fever/chemically induced , Fever/drug therapy , Fever/epidemiology , Headache/chemically induced , Headache/epidemiology , Humans , Male , Middle Aged , Myalgia/chemically induced , Myalgia/epidemiology , Nausea/chemically induced , Nausea/drug therapy , Nausea/epidemiology , Patient Readmission/statistics & numerical data , Republic of Korea , Retrospective Studies , Software Design , Tertiary Care Centers/statistics & numerical data , Triage , Young Adult
7.
Ann R Coll Surg Engl ; 103(7): 524-529, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288677

ABSTRACT

INTRODUCTION: Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS: A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS: Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION: With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.


Subject(s)
Bariatric Surgery/adverse effects , COVID-19/prevention & control , Elective Surgical Procedures/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Adult , Bariatric Surgery/standards , Bariatric Surgery/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Clinical Protocols/standards , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Enhanced Recovery After Surgery/standards , Feasibility Studies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Postoperative Complications/etiology , Prospective Studies , Retrospective Studies , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/organization & administration , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
8.
Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288676

ABSTRACT

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Emergency Treatment/statistics & numerical data , General Surgery/organization & administration , Surgery Department, Hospital/organization & administration , Adult , Aged , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Conservative Treatment/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/methods , Emergency Treatment/standards , Female , Follow-Up Studies , General Surgery/standards , General Surgery/statistics & numerical data , Hospital Mortality , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Patient Safety/standards , Prospective Studies , Referral and Consultation/organization & administration , Referral and Consultation/standards , Referral and Consultation/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
9.
J Med Virol ; 93(9): 5458-5473, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1272201

ABSTRACT

Kawasaki-like disease (KLD) and multisystem inflammatory syndrome in children (MIS-C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID-19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS-C associated with COVID-19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS-C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two-thirds of the children with KLD associated with COVID-19 had been admitted to PICUs, around one-fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID-19.


Subject(s)
Brain Infarction/complications , COVID-19/complications , Heart Failure/complications , Mucocutaneous Lymph Node Syndrome/complications , SARS-CoV-2/pathogenicity , Shock/complications , Systemic Inflammatory Response Syndrome/complications , Adolescent , Brain Infarction/diagnostic imaging , Brain Infarction/mortality , Brain Infarction/virology , COVID-19/diagnostic imaging , COVID-19/mortality , COVID-19/virology , Child , Child, Preschool , Female , Heart Failure/diagnostic imaging , Heart Failure/mortality , Heart Failure/virology , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Mucocutaneous Lymph Node Syndrome/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/mortality , Mucocutaneous Lymph Node Syndrome/virology , Patient Readmission/statistics & numerical data , Respiration, Artificial , SARS-CoV-2/physiology , Shock/diagnostic imaging , Shock/mortality , Shock/virology , Survival Analysis , Systemic Inflammatory Response Syndrome/diagnostic imaging , Systemic Inflammatory Response Syndrome/mortality , Systemic Inflammatory Response Syndrome/virology
10.
J Am Geriatr Soc ; 69(10): 2745-2751, 2021 10.
Article in English | MEDLINE | ID: covidwho-1268122

ABSTRACT

BACKGROUND/OBJECTIVES: Transitional care management (TCM) visits delivered following hospitalization have been associated with reductions in mortality, readmissions, and total costs; however, uptake remains low. We sought to describe trends in TCM visit delivery during the COVID-19 pandemic. DESIGN: Cross-sectional study of ambulatory electronic health records from December 30, 2019 and January 3, 2021. SETTING: United States. PARTICIPANTS: Forty four thousand six hundred and eighty-one patients receiving transitional care management services. MEASUREMENTS: Weekly rates of in-person and telehealth TCM visits before COVID-19 was declared a national emergency (December 30, 2019 to March 15, 2020), during the initial pandemic period (March 16, 2020 to April 12, 2020) and later period (April 12, 2020 to January 3, 2021). Characteristics of patients receiving in-person and telehealth TCM visits were compared. RESULTS: A total of 44,681 TCM visits occurred during the study period with the majority of patients receiving TCM visits age 65 years and older (68.0%) and female (55.0%) Prior to the COVID-19 pandemic, nearly all TCM visits were conducted in-person. In the initial pandemic, there was an immediate decline in overall TCM visits and a rise in telehealth TCM visits, accounting for 15.4% of TCM visits during this period. In the later pandemic, the average weekly number of TCM visits was 841 and 14.0% were telehealth. During the initial and later pandemic periods, 73.3% and 33.6% of COVID-19-related TCM visits were conducted by telehealth, respectively. Across periods, patterns of telehealth use for TCM visits were similar for younger and older adults. CONCLUSION: The study findings highlight a novel and sustained shift to providing TCM services via telehealth during the COVID-19 pandemic, which may reduce barriers to accessing a high-value service for older adults during a vulnerable transition period. Further investigations comparing outcomes of in-person and telehealth TCM visits are needed to inform innovation in ambulatory post-discharge care.


Subject(s)
Aftercare , Ambulatory Care/statistics & numerical data , COVID-19 , Telemedicine , Transitional Care , Aftercare/methods , Aftercare/trends , Aged , COVID-19/mortality , COVID-19/prevention & control , COVID-19/therapy , Costs and Cost Analysis , Cross-Sectional Studies , Electronic Health Records/statistics & numerical data , Female , Humans , Male , Massachusetts/epidemiology , Mortality , Patient Discharge , Patient Readmission/statistics & numerical data , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Telemedicine/trends , Transitional Care/organization & administration , Transitional Care/trends
11.
J Med Virol ; 93(9): 5582-5587, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1245503

ABSTRACT

Identify factors associated with readmission after an index hospital admission for coronavirus disease 2019 (COVID-19) infection in a single center serving an underserved and predominantly minority population. This retrospective descriptive study included 275 patients who tested COVID-19 positive via reverse transcriptase-polymerase chain reaction assay at our institution and who survived the index hospitalization. The main outcomes were 1- and 6-month readmission rates after an index hospitalization for COVID-19. The mortality rate among the readmitted patients was also determined. Factors independently associated with readmission were investigated using multivariable logistic regression. A final sample of 275 patients was included. The mean age was 64.69 ± 14.64 (SD), 133 (48%) were female and 194 (70%) were African American. Their chronic medical conditions included hypertension 203 (74%) and diabetes mellitus 121 (44%). After the hospitalization, 1-month readmission rate was 7.6%, while 6-month readmission rate was 24%. Nine percent of patients who were readmitted subsequently died. Coronary artery disease (CAD) was significantly associated with 6-month readmission odds ratio (OR), 2.15 (95% confidence interval [CI]: 1.04-4.44; p = 0.039) after adjustment for age, gender, ethnicity, and comorbidities. Readmissions were due to cardiac, respiratory, and musculoskeletal symptoms. Hispanic ethnicity was associated with increased readmission OR, 3.16 (95% CI: 1.01-9.88; p = 0.048). No significant difference was found between inflammatory markers or clinical outcomes during the index hospitalization among patients who were readmitted compared to those who were not. A significant number of patients hospitalized for COVID-19 may be readmitted. The presence of CAD is independently associated with high rates of 6-month readmission.


Subject(s)
COVID-19/therapy , Patient Readmission/statistics & numerical data , SARS-CoV-2 , Aged , COVID-19/mortality , Comorbidity , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Pennsylvania/epidemiology , Retrospective Studies , Risk Factors , Time Factors
12.
Ann Intern Med ; 174(5): 613-621, 2021 05.
Article in English | MEDLINE | ID: covidwho-1239133

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN: Single-health system, multihospital retrospective cohort study. SETTING: 5 hospitals within the University of Pennsylvania Health System. PATIENTS: Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic. MEASUREMENTS: The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions. RESULTS: Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. LIMITATIONS: Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications. CONCLUSION: Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Critical Illness/mortality , Critical Illness/therapy , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Shock/mortality , Shock/therapy , APACHE , Academic Medical Centers , Aged , Female , Hospital Mortality , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Patient Readmission/statistics & numerical data , Pennsylvania/epidemiology , Pneumonia, Viral/virology , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Shock/virology , Survival Rate
13.
Am J Emerg Med ; 47: 239-243, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1212999

ABSTRACT

BACKGROUND: The global healthcare burden of COVID-19 continues to rise. There is currently limited information regarding the disease progression and the need for hospitalizations in patients who present to the Emergency Department (ED) with minimal or no symptoms. OBJECTIVES: This study identifies bounceback rates and timeframes for patients who return to the ED due to COVID-19 after initial discharge on the date of testing. METHODS: Using the NorthShore University Health System's (NSUHS) Enterprise Data Warehouse (EDW), we conducted a retrospective cohort analysis of patients who were tested positive for COVID-19 and were discharged home on the date of testing. A one-month follow-up period was included to ensure the capture of disease progression. RESULTS: Of 1883 positive cases with initially mild symptoms, 14.6% returned to the ED for complaints related to COVID-19. 56.9% of the mildly symptomatic bounceback patients were discharged on the return visit while 39.5% were admitted to the floor and 3.6% to the ICU. Of the 1120 positive cases with no initial symptoms, only four returned to the ED (0.26%) and only one patient was admitted. Median initial testing occurred on day 3 (2-5.6) of illness, and median ED bounceback occurred on day 9 (6.3-12.7). Our statistical model was unable to identify risk factors for ED bouncebacks. CONCLUSION: COVID-19 patients diagnosed with mild symptoms on initial presentation have a 14.6% rate of bounceback due to progression of illness.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Patient Readmission/statistics & numerical data , Adult , Aged , Female , Health Services Accessibility , Humans , Illinois/epidemiology , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Severity of Illness Index
15.
Am J Emerg Med ; 46: 146-149, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1198572

ABSTRACT

INTRODUCTION: Little is known on prevalence of early return hospital admission of subjects with COVID-19 previously evaluated and discharged from emergency departments (EDs). This study aims to describe readmission rate within 14 days of patients with COVID-19 discharged from ED and to identify predictors of return hospital admission. METHODS: We performed a retrospective cohort study of adult patients with COVID-19 discharged from two EDs. Return hospital admission was defined as an unscheduled return ED visit within 14 days after initial ED evaluation and discharge. We compared the group of patients who had a return hospital admission to those who did not. We also evaluated selected clinical characteristics (age, neutrophilia, SOFA, lactate dehydrogenase, C-reactive protein and D-dimer) associated with return hospital admission. RESULTS: Of 283 patients included in the study, 65 (22.9%) had a return ED visit within 14 days. 32 of those patients (11%) were then hospitalized, while the remaining 33 were again discharged. Patients requiring a return hospital admission was significantly older, had higher pro-calcitonin and D-dimer levels. Major predictors of return hospital admission were cognitive impairment (OR 17.3 [CI 4.7-63.2]), P/F < 300 mmHg (OR 8.6 [CI 1.6-44.3]), being resident in geriatric care facility (OR 7.6 [CI 2.1-26.4]) and neutrophilia (OR 5.8 [CI 1.6-22.0]). CONCLUSION: Several factors are associated with 14-day return hospital admission in COVID-19 subjects. These should be considered when assessing discharge risk in ED clinical practice.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Patient Discharge/statistics & numerical data , Patient Readmission/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
16.
J Patient Saf ; 17(4): 264-269, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1183095

ABSTRACT

OBJECTIVE: The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals. METHODS: This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge. RESULTS: Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization. CONCLUSIONS: Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.


Subject(s)
COVID-19/therapy , Hospitals, Urban/statistics & numerical data , Patient Readmission/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Retrospective Studies
17.
Am J Med Qual ; 36(2): 84-89, 2021.
Article in English | MEDLINE | ID: covidwho-1172661

ABSTRACT

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.


Subject(s)
COVID-19/epidemiology , Patient Discharge/standards , Patient Safety/standards , Academic Medical Centers , Age Factors , Clinical Protocols , Comorbidity , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Inflammation Mediators/blood , Male , Middle Aged , Patient Readmission/statistics & numerical data , Risk Assessment , SARS-CoV-2
18.
BMJ ; 372: n693, 2021 03 31.
Article in English | MEDLINE | ID: covidwho-1166413

ABSTRACT

OBJECTIVE: To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN: Retrospective cohort study. SETTING: NHS hospitals in England. PARTICIPANTS: 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES: Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS: Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS: Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.


Subject(s)
COVID-19/complications , Hospitalization/statistics & numerical data , Multiple Organ Failure/epidemiology , Patient Readmission/statistics & numerical data , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/virology , Cardiovascular Diseases/epidemiology , Case-Control Studies , Diabetes Mellitus/epidemiology , England/epidemiology , Female , Humans , Male , Middle Aged , Patient Discharge/statistics & numerical data , Respiratory Tract Diseases/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
20.
PLoS One ; 16(3): e0249043, 2021.
Article in English | MEDLINE | ID: covidwho-1146693

ABSTRACT

BACKGROUND: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. METHODS: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. RESULTS: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. CONCLUSIONS: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.


Subject(s)
COVID-19/pathology , Cardiovascular Diseases/diagnosis , Heart Failure/diagnosis , Hospitalization/statistics & numerical data , Adult , Aged , Ambulatory Care Facilities , COVID-19/virology , Cardiovascular Diseases/mortality , Databases, Factual , Female , Heart Failure/mortality , Heart Failure/therapy , Heart Transplantation , Humans , Male , Middle Aged , Patient Readmission/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Survival Rate
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