Anil N Makam1, Oanh K Nguyen1, Christopher Clark2, Ethan A Halm1. 1. Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Division of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, TX. 2. Office of Research Administration, Parkland Health and Hospital System, Dallas, TX.
Abstract
BACKGROUND: Although hypothesized to be a hazard of hospitalization, it is unclear whether hospital-acquired anemia (HAA) is associated with increased adverse outcomes following discharge. OBJECTIVE: To examine the incidence, predictors, and postdischarge outcomes associated with HAA. DESIGN: Observational cohort study using electronic health record data. SUBJECTS: Consecutive medicine discharges between November 1, 2009 and October 30, 2010 from 6 Texas hospitals, including safety-net, teaching, and nonteaching sites. Patients with anemia on admission or missing hematocrit values at admission or discharge were excluded. MEASURES: HAA was defined using the last hematocrit value prior to discharge and categorized by severity. The primary outcome was a composite of 30-day mortality and nonelective readmission. RESULTS: Among 11,309 patients, one-third developed HAA (21.6% with mild HAA; 10.1% with moderate HAA; and 1.4% with severe HAA). The 2 strongest potentially modifiable predictors of developing moderate or severe HAA were length of stay (adjusted odds ratio [OR], 1.26 per day; 95% confidence interval [CI], 1.23-1.29) and receipt of a major procedure (adjusted OR, 5.09; 95% CI, 3.79-6.82). Patients without HAA had a 9.7% incidence for the composite outcome versus 16.4% for those with severe HAA. Severe HAA was independently associated with a 39% increase in the odds for 30-day readmission or death (95% CI, 1.09-1.78). Most patients with severe HAA (85%) underwent a major procedure, had a discharge diagnosis of hemorrhage, and/or a discharge diagnosis of hemorrhagic disorder. CONCLUSIONS: Severe HAA is associated with increased odds for 30-day mortality and readmission after discharge; however, it is uncertain whether severe HAA is preventable. Journal of Hospital Medicine 2017;12:317-322.
BACKGROUND: Although hypothesized to be a hazard of hospitalization, it is unclear whether hospital-acquired anemia (HAA) is associated with increased adverse outcomes following discharge. OBJECTIVE: To examine the incidence, predictors, and postdischarge outcomes associated with HAA. DESIGN: Observational cohort study using electronic health record data. SUBJECTS: Consecutive medicine discharges between November 1, 2009 and October 30, 2010 from 6 Texas hospitals, including safety-net, teaching, and nonteaching sites. Patients with anemia on admission or missing hematocrit values at admission or discharge were excluded. MEASURES: HAA was defined using the last hematocrit value prior to discharge and categorized by severity. The primary outcome was a composite of 30-day mortality and nonelective readmission. RESULTS: Among 11,309 patients, one-third developed HAA (21.6% with mild HAA; 10.1% with moderate HAA; and 1.4% with severe HAA). The 2 strongest potentially modifiable predictors of developing moderate or severe HAA were length of stay (adjusted odds ratio [OR], 1.26 per day; 95% confidence interval [CI], 1.23-1.29) and receipt of a major procedure (adjusted OR, 5.09; 95% CI, 3.79-6.82). Patients without HAA had a 9.7% incidence for the composite outcome versus 16.4% for those with severe HAA. Severe HAA was independently associated with a 39% increase in the odds for 30-day readmission or death (95% CI, 1.09-1.78). Most patients with severe HAA (85%) underwent a major procedure, had a discharge diagnosis of hemorrhage, and/or a discharge diagnosis of hemorrhagic disorder. CONCLUSIONS: Severe HAA is associated with increased odds for 30-day mortality and readmission after discharge; however, it is uncertain whether severe HAA is preventable. Journal of Hospital Medicine 2017;12:317-322.
Authors: Adam C Salisbury; Karen P Alexander; Kimberly J Reid; Frederick A Masoudi; Saif S Rathore; Tracy Y Wang; Richard G Bach; Steven P Marso; John A Spertus; Mikhail Kosiborod Journal: Circ Cardiovasc Qual Outcomes Date: 2010-05-20
Authors: Adam C Salisbury; Mikhail Kosiborod; Amit P Amin; Kimberly J Reid; Karen P Alexander; John A Spertus; Frederick A Masoudi Journal: Am J Cardiol Date: 2011-07-23 Impact factor: 2.778
Authors: Colleen G Koch; Liang Li; Zhiyuan Sun; Eric D Hixson; Anne Tang; Shannon C Phillips; Eugene H Blackstone; J Michael Henderson Journal: J Hosp Med Date: 2013-07-19 Impact factor: 2.960
Authors: Howard L Corwin; Andrew Gettinger; Ronald G Pearl; Mitchell P Fink; Mitchell M Levy; Edward Abraham; Neil R MacIntyre; M Michael Shabot; Mei-Sheng Duh; Marc J Shapiro Journal: Crit Care Med Date: 2004-01 Impact factor: 7.598
Authors: Ruben Amarasingham; Ferdinand Velasco; Bin Xie; Christopher Clark; Ying Ma; Song Zhang; Deepa Bhat; Brian Lucena; Marco Huesch; Ethan A Halm Journal: BMC Med Inform Decis Mak Date: 2015-05-20 Impact factor: 2.796
Authors: Joon Seok Choi; Young A Kim; Yong Un Kang; Chang Seong Kim; Eun Hui Bae; Seong Kwon Ma; Young-Keun Ahn; Myung Ho Jeong; Soo Wan Kim Journal: PLoS One Date: 2013-09-24 Impact factor: 3.240
Authors: Yu Wu; Aaron C Spaulding; Shalmali Borkar; Michelle M Shoaei; Maria Mendoza; Rhonda L Grant; Bruce W Barber; Gretchen S Johns; Pablo Moreno Franco Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-11-19
Authors: Oanh Kieu Nguyen; Anil N Makam; Christopher Clark; Song Zhang; Sandeep R Das; Ethan A Halm Journal: J Am Heart Assoc Date: 2018-04-17 Impact factor: 5.501
Authors: Mirela Tiglis; Cristian Cobilinschi; Liliana Elena Mirea; Alexandru Emil Băetu; Ileana Peride; Tiberiu Paul Neagu; Andrei Niculae; Ionel Alexandru Checherită; Ioana Marina Grintescu Journal: J Crit Care Med (Targu Mures) Date: 2021-08-05