A study finds that the first 10 days after leaving a hospital have a high risk for patients with COVID-19

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In the first months after their hospital COVID-19, patients face a high risk of ongoing health problems, trips back to the hospital and death, an increasing number of studies have shown.

But the first week and a half can be especially dangerous, according to a new study in JAMA of a team from the University of Michigan and VA Ann Arbor Healthcare System.

COVID-19 patients had a 40% to 60% higher risk of ending up back in the hospital or dying in the first 10 days, compared with similar patients treated in the same hospitals during the same months due to heart failure or pneumonia.

At the end of 60 days, the overall risk of readmission or death of the COVID-19 patients was lower than that for the other two major conditions.

Despite this, in the first two months, 9% of the COVID-19 patients who survived hospitalization died, and nearly 20% suffered a failure that returned them to the hospital.

This is in addition to the 18.5% who died during their hospitalization.

The researchers compared posthospital outcomes for nearly 2,200 veterans who survived their hospitalization in 132 VA hospitals for COVID-19 this spring and summer, with results for nearly 1,800 similar patients who survived a stay for pneumonia unrelated to COVID. 19, and 3,500 who survived a heart failure relationship, during the same time period.

Special attention is required

With hundreds of thousands of Americans now hospitalized for severe cases of COVID-19, and hospitals working to clear beds for a sustained increase, the study suggests a need for special attention in the first days after resignation, says John P. Donnelly, Ph .D. , MSPH, MS, the first author of the study and an epidemiologist in the Department of Health Sciences Learning at Michigan Medicine, UM’s academic medical center.

“Comparing the long-term outcomes of COVID-19 patients with those of other seriously ill patients, we see a pattern of even greater than usual risk right in the first one to two weeks, which can be a risky period for anyone,” says Donnelly , who is a scholar in a special training program for researchers on critical illness data at UM’s Institute for Health Policy and Innovation.

“Now the question is what to do about it,” he says. “How can we design better discharge plans for these patients? How can we adapt our communication and post-hospital care to their needs? And how can we help their caregivers prepare and cope?”

Constructive evidence

Donnelly worked on the study with Michigan Medicine and VAAHS physicians Hallie Prescott, MD, M.Sc., and Theodore Iwashyna, MD, Ph.D.

Prescott is a senior author of another recent article that shows slow recovery in COVID-19 patients hospitalized in Michigan hospitals during the state’s spring rise.

“Unfortunately,” says Iwashyna, “this is even more evidence that COVID-19 is not“ one and done. ”For many patients, COVID-19 seems to cause cascades of problems that are as serious as those we have. see in other diseases. But too little of our medical response – and too little research – is designed to help these patients while they last. for days, weeks, even months to recover after COVID-19. “

Iwashyna further notes, “It is likely that very similar patterns are occurring in the private sector, but the VA had the data to be able to look at soon.”

More on the study

The study did not include non-veterans treated in VA hospitals in early states, through the “Fourth Mission” program, which compensated for bed deficiencies in non-VA hospitals. It also does not include any readmissions to non-VA hospitals.

All but 5% of the patients were male, and half were Black, which is not nationally representative but focuses on two at-risk groups. But within the veterans studied, the only factor that made a significant difference in outcomes was age; about half of veterans in their 70-80 years died in the 60 days after leaving the hospital.

A total of 2,179 patients with COVID-19 spent a total of 27,496 days in the hospital, and the 354 veterans readmitted spent a total of 3,728 additional days in the hospital.

The most common reasons listed for rehospitalization were COVID-19, cited in 30% of patients, and sepsis seen in 8.5%. More than 22% of the readmitted veterans went to an intensive care unit.

The study included patients with all three conditions, whose hospital stays began in the period from March 1 to June 1, and left the hospital by July 1.

Because these were the early months of the pandemic, Donnelly acknowledges that the experience gained by hospitals during that time, and shared with hospitals in other states with subsequent increases, may have altered posthospital outcomes.

But the current increase, which is causing hospitals to attract non-specialists to care for COVID-19, and to care for other seriously ill patients, may have a negative impact.

He and his colleagues hope to continue to study new data from VA and non-VA hospitals when they become available, and compare COVID-19 posthospital outcomes with those for other serious conditions. Comparisons with patients hospitalized for influenza and other viral diseases would be important to study, given the widespread false claims that COVID-19 is only a minor disease.


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Additional information:
John P. Donnelly et al, Rehabilitation and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multistospital System, JAMA (2020). DOI: 10.1001 / jama.2020.21465

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Quote: First 10 days after leaving hospital have high risk for patients with COVID-19, study findings (2020, 14 December) downloaded 15 December 2020 from https://medicalxpress.com/news/2020-12-days-hospital-high -covid -patients.html

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