Hospital‐acquired anemia: Prevalence, outcomes, and healthcare implications

Koch, Colleen G.; Liang, Li; Sun, Zhiyuan; Hixson, Eric D.; Tang, Anne; Phillips, Shannon; Blackstone, Eugene H.; Henderson, J. Michael

doi:10.1002/jhm.2061

Cited by 134 publications

(104 citation statements)

References 29 publications

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“…[19][20][21][22][23][24][25][26][27][28][29] To assess a dose-response relationship between an increasing number of instabilities and adverse outcomes, we used the Cochran-Armitage test for trend. We accounted for clustering of patients by hospital using generalized estimating equations.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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BACKGROUND: Vital sign instability on discharge could be a clinically objective means of assessing readiness and safety for discharge; however, the association between vital sign instability on discharge and post-hospital outcomes is unclear. OBJECTIVE: To assess the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. DESIGN: Multi-center observational cohort study using electronic health record data. Abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation were assessed within 24 hours of discharge. We used logistic regression adjusted for predictors of 30-day death and readmission. PARTICIPANTS: Adults (≥18 years) with a hospitalization to any medicine service in 2009-2010 at six hospitals (safety-net, community, teaching, and non-teaching) in north Texas. MAIN MEASURES: Death or non-elective readmission within 30 days after discharge. KEY RESULTS: Of 32,835 individuals, 18.7 % were discharged with one or more vital sign instabilities. Overall, 12.8 % of individuals with no instabilities on discharge died or were readmitted, compared to 16.9 % with one instability, 21.2 % with two instabilities, and 26.0 % with three or more instabilities (p < 0.001). The presence of any (≥1) instability was associated with higher risk-adjusted odds of either death or readmission (AOR 1.36, 95 % CI 1.26-1.48), and was more strongly associated with death (AOR 2.31, 95 % CI 1.91-2.79). Individuals with three or more instabilities had nearly fourfold increased odds of death (AOR 3.91, 95 % CI 1.69-9.06) and increased odds of 30-day readmission (AOR 1.36, 95 % 0.81-2.30) compared to individuals with no instabilities. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 % and positive likelihood ratio of 1.8 for 30-day death or readmission. CONCLUSIONS: Vital sign instability on discharge is associated with increased risk-adjusted rates of 30-day mortality and readmission. These simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmissions.

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Section: Discussionmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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“…The prevalence of anemia in hospitalized patients ranges from that in the general population to much higher, depending on the reason for admission, co-morbidities and patient factors such as age and gender; the reported prevalence is at least 25-50% and may be higher, with the elderly and those with chronic conditions at increased risk [33,34]. Also, 74% of hospitalized patients will develop a hospitalacquired anemia [35] with 95% of patients admitted to the intensive care unit (ICU) developing anemia by the third ICU day [36]. A surgical procedure with a moderate or high blood loss will further aggravate the anemia and deplete iron stores.…”

Section: Preoperative Anemia Evaluation and Readiness For Surgerymentioning

confidence: 99%

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Freedman¹

2016

J Perioper Crit Intensive Care Nurs

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Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as 'Bloodless Medicine/Surgery') is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches.

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“…The condition is common, with an incidence ranging from approximately 25% when defined by using the hemoglobin value prior to discharge to 74% when using the nadir hemoglobin value during hospitalization. [1][2][3][4][5] While there are many potential etiologies for HAA, given that iatrogenic blood loss from phlebotomy may lead to its development, 6,7 HAA has been postulated to be a hazard of hospitalization that is potentially preventable. 8 However, it is unclear whether the development of HAA portends worse outcomes after hospital discharge.…”

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confidence: 99%

Incidence, Predictors, and Outcomes of Hospital‐Acquired Anemia

Makam

Nguyen

Clark

et al. 2017

Journal of Hospital Medicine

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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.

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Hospital‐acquired anemia: Prevalence, outcomes, and healthcare implications

Cited by 134 publications

References 29 publications

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Incidence, Predictors, and Outcomes of Hospital‐Acquired Anemia

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