A systematic review and meta-analysis of the characteristics and outcomes of readmitted COVID-19 survivors.

Subramaniam, Ashwin; Lim, Zheng Jie; Ponnapa Reddy, Mallikarjuna; Shekar, Kiran

OBJECTIVE To investigate the incidence, characteristics, and outcomes of patients who were readmitted to hospital emergency departments or required re-hospitalization following an index hospitalization with a diagnosis of COVID-19. DATA SOURCES A systematic review of PubMed, EMBASE, and pre-print websites was conducted between January 1 and December 31, 2020. STUDY SELECTION Studies reporting on the incidence, characteristics, and outcomes of patients with COVID-19 who represent or require hospital admission were included. DATA EXTRACTION Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines. RESULTS Six studies reporting on 547 readmitted patients were included. The overall incidence was 4.4%; more commonly in male (57.2%), due to respiratory distress or prolonged COVID-19. Readmitted patients had a shorter initial hospital length of stay (LOS) compared to those with a single hospitalisation (8.1±10.6 vs. 13.9±10.2 days). The mean time to readmission was 7.6±6.0 days; the mean LOS upon re-hospitalisation was 6.3±5.6 days. Hypertension (OR=2.08; 95%-CI 1.69-2.55; p<0.001; I2 =0%), diabetes (OR=1.77; 95%-CI 1.38-2.27; p<0.001; I2 =0%) and renal failure (OR=2.37; 95%-CI 1.09-5.14; p<0.001; I2 =0%) were more common in these patients. Intensive care admission rates were similar between the two groups. 12.8% of readmitted patients (22/172) died. CONCLUSIONS Readmitted patients following an index hospitalization for COVID-19 were more commonly male with multiple comorbidities. Shorter initial hospital LOS and unresolved primary illness may have contributed to readmission. This article is protected by copyright. All rights reserved.