Study Examines Readmission Rates for Veterans who Survived COVID-19–Prior to Availability of Vaccine

BACKGROUND:
Much has been published about the acute effects of COVID-19; less is known about people who survive hospitalization and are discharged. Thirty-day readmissions following a COVID-19 hospitalization across studies and countries have averaged around 8-9%. However, early data suggest that Veterans hospitalized with COVID-19 in the VA healthcare system may have experienced higher readmission rates than the general population. This study examined VA hospital readmissions within 90 days following discharges during three initial waves of COVID-19 infection in the first year of the pandemic – prior to the availability of a vaccine. Using VA data, investigators identified 20,414 Veterans who were hospitalized with a positive COVID-19 test between March 1 and December 31, 2020. They then assessed readmission for acute care within 90 days of the initial COVID-19 discharge. Socio-demographics also were analyzed, in addition to insurance status, rural vs. urban residence, and clinical characteristics (i.e., smoking status, body mass index, ventilation required).

FINDINGS:

• Approximately 1 of every 6 Veterans discharged alive following a COVID-19 hospitalization were readmitted within 90 days. Among COVID survivors in this study (n=17,771), 16% were readmitted within 90 days of hospital discharge – with a mean time to readmission of nearly 22 days.
• Readmissions were more likely when the initial admission was longer, required mechanical ventilation, or the Veteran had more comorbidities, smoked, or lived in an urban area.
• More than 60% of readmissions were due to a reason other than infectious disease, even COVID.
• Twenty-two percent of Veterans readmitted died within 90 days of their initial hospitalization vs. 11% of Veterans not readmitted. Thirteen percent of the Veterans in this study (n=2,643) died during their initial COVID-19 hospitalization.

IMPLICATIONS:

• Readmissions for possible COVID-19-related issues within a short time of initial discharge in a subset of this study cohort point to the need to continue to monitor outcomes – and to identify interventions to mitigate these negative consequences.

LIMITATIONS:

• Results were based on initial infections that occurred prior to the availability of vaccines, which has had a significant impact on outcomes. Without a control group of patients hospitalized for other conditions, readmissions cannot be attributed to COVID specifically. Previous studies have documented high rates of readmissions after hospitalization for influenza.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (C19 20-208, SDR 18-321). Drs. Weaver and Hynes were supported by HSR&D Research Career Scientist Awards, and Dr. Edwards is supported by an HSR&D Career Development Award. Drs. Weaver and Gordon are part of HSR&D’s Center of Innovation for Complex Chronic Healthcare (CINCCH); Dr. Niederhausen, Mr. Hickok, Ms. O’Neill, Drs. Edwards, Govier, and Chen, Ms. Young, and Dr. Hynes are all part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC); and Dr. Whooley is part of part of Measurement Science QUERI.

Weaver F, Niederhausen M, Hickok A, O’Neill A, Gordon H, Edwards S, Govier D, Chen J, Young R, Whooley M, and Hynes D. Hospital Readmissions Among Veterans within 90 Days of Discharge Following Initial Hospitalization for COVID-19. Preventing Chronic Illness. December 1, 2022;19:E80.