Incidence, Patient-Directed Discharge, Readmission, and Mortality Among People Hospitalized With Injecting-Related...

Despite increasing hospitalization for injecting-related infection, there has been limited large-scale evaluation of in-hospital and post-discharge outcomes. This study aimed to characterize population-level injecting-related infection hospitalization and correlates associated with patient-directed discharge, readmission, and all-cause mortality among persons who inject drugs with hepatitis C in New South Wales, Australia, between 2001 and 2022.

Hepatitis C notifications in New South Wales were linked to data involving hospitalizations, opioid agonist treatment, incarceration, and death registration. Hospitalizations among people who inject drugs with injecting-related infections were identified by ICD-10 code algorithms. Incidence of patient-directed discharge, readmission, and mortality was calculated, and correlates associated with each outcome were assessed by extension of a Cox proportional hazards model for recurrent events.

In total, 18074 injecting-related infection hospitalizations were included among 9045 individuals, predominantly males (64%) with an average age of 41 years. The incidence was 47.2 per 100 person-years and increased over time. The proportion of hospitalizations ending in patient-directed discharge was 18% and was associated with stimulant use and incarceration, and lower in those with severe disease and opiate agonist therapy. The proportions of hospitalizations that were followed by 30-day and 1-year readmission were 25% and 61%, respectively, and had a strong association with patient-directed discharge. Mortality was 2% at 30 days and 15% at 1 year post-discharge.

Patient-directed discharge was common among people admitted with injecting-related infections and was associated with readmission but not mortality. Person-centered models of care are necessary to address the health inequity experienced by people who inject drugs.