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Magnitude of Anemia at Discharge Increases 30-Day Hospital Readmissions

Koch, Colleen G. MD, MS, MBA*†; Li, Liang PhD; Sun, Zhiyuan MS; Hixson, Eric D. PhD§; Tang, Anne MS; Chagin, Kevin MS; Kattan, Michael PhD†‡; Phillips, Shannon C. MD; Blackstone, Eugene H. MD‡∥; Henderson, J. Michael MD†¶

doi: 10.1097/PTS.0000000000000138
Original Articles

Background Anemia during hospitalization is associated with poor health outcomes. Does anemia at discharge place patients at risk for hospital readmission within 30 days of discharge? Our objectives were to examine the prevalence and magnitude of anemia at hospital discharge and determine whether anemia at discharge was associated with 30-day readmissions among a cohort of hospitalizations in a single health care system.

Methods From January 1, 2009, to August 31, 2011, there were 152,757 eligible hospitalizations within a single health care system. The endpoint was any hospitalization within 30 days of discharge. The University HealthSystem Consortium's clinical database was used for demographics and comorbidities; hemoglobin values are from the hospitals' electronic medical records, and readmission status was obtained from the University HealthSystem Consortium administrative data systems. Mild anemia was defined as hemoglobin of greater than 11 to less than 12 g/dl in women and greater than 11 to less than 13 g/dl in men; moderate, greater than 9 to less than or equal to 11 g/dl; and severe, less than or equal to 9 g/dl. Logistic regression was used to assess the association of anemia and 30-day readmissions adjusted for demographics, comorbidity, and hospitalization type.

Results Among 152,757 hospitalizations, 72% of patients were discharged with anemia: 31,903 (21%), mild; 52,971 (35%), moderate; and 25,522 (17%), severe. Discharge anemia was associated with severity-dependent increased odds for 30-day hospital readmission compared with those without anemia: for mild anemia, 1.74 (1.65–1.82); moderate anemia, 2.76 (2.64–2.89); and severe anemia, 3.47 (3.30–3.65), P < 0.001.

Conclusions Anemia at discharge is associated with a severity-dependent increased risk for 30-day readmission. A strategy focusing on anemia treatment care paths during index hospitalization offers an opportunity to influence subsequent readmissions.

From the *Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, †Quality and Patient Safety Institute, ‡Department of Quantitative Health Sciences, Research Institute, §Business Intelligence, Medical Operations, ∥Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, and ¶Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Correspondence: Colleen G. Koch, MD, MS, MBA, Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/Mail Stop J-4, Cleveland, OH 44195 (e-mail:

The authors disclose no conflict of interest.

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