Publication Date
3-1-2024
Journal
Annals of the American Thoracic Society
DOI
10.1513/AnnalsATS.202305-491OC
PMID
38134434
PMCID
PMC10913765
PubMedCentral® Posted Date
3-1-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Adult, Humans, United States, Patient Readmission, Cohort Studies, Quality of Life, Aftercare, COVID-19, Patient Discharge, Lung Diseases, Interstitial, Pneumonia, lung diseases, interstitial, patient readmission, COVID-19, mortality
Abstract
Rationale
Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset.
Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital.
Methods
This study is a nested cohort study that used the PearlDiver patient records database. Adult patients (age ⩾18 yr) who were admitted to hospitals in 28 states in the United States with COVID-19 or ILD diagnoses were included. We defined and analyzed two separate cohorts in this study. The first cohort consisted of patients with COVID-19 and was later divided into two groups with or without a history of ILD. The second cohort consisted of patients with ILD and was later divided into groups with COVID-19 or with a non–COVID-19 pneumonia diagnosis at admission. We also studied two other subcohorts of patients with and without idiopathic pulmonary fibrosis within the second cohort. Propensity score matching was employed to match confounders between groups. The Kaplan-Meier log rank test was applied to compare the probabilities of outcomes.
Results
We assessed the data of 2,286,775 patients with COVID-19 and 118,892 patients with ILD. We found that patients with COVID-19 with preexisting ILD had an odds ratio of 1.6 for 30-day all-cause readmission. Similarly, an odds ratio of 2.42 in readmission rates was observed among hospitalized individuals with ILD who contracted COVID-19 compared with those who were hospitalized for non–COVID-19 pneumonia. Our study also found a significantly higher probability of intensive care admission among patients in both cohorts.
Conclusions
Patients with ILD face heightened rates of hospital readmissions, particularly when ILD is combined with COVID-19, resulting in adverse outcomes such as decreased quality of life and increased healthcare expenses. It is imperative to prioritize preventive measures against COVID-19 and establish effective postdischarge care strategies for patients with ILD.
Included in
Clinical Epidemiology Commons, COVID-19 Commons, Critical Care Commons, Internal Medicine Commons, Medical Sciences Commons, Pulmonology Commons, Sleep Medicine Commons