Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care
Summary Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post‐hospitalisation outcom...
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| Veröffentlicht in: | Anaesthesia 2023-01, Vol.78 (1), p.45-54 |
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| creator | Warner, M. A. Hanson, A. C. Plimier, C. Lee, C. Liu, V. X. Richards, T. Kor, D. J. Roubinian, N. H. |
| description | Summary
Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post‐hospitalisation outcomes, with a primary outcome of 30 day unanticipated hospital readmissions. This investigation includes data from two independent population‐based observational cohorts of adult surgical patients (aged ≥ 18 years) requiring postoperative intensive care unit admission between 1 January 2010 and 31 December 2019 in hospitals in Olmsted County, Minnesota, and between 1 July 2010 and 30 June 2017 in the Kaiser Permanente Northern California integrated healthcare system, California. Cox proportional hazards models assessed the associations between discharge haemoglobin concentrations (per 10 g.l–1) and outcomes, with prespecified multivariable adjustment. A total of 3260 patients were included from Olmsted County hospitals and 29,452 from Kaiser Permanente Northern California. In adjusted analyses, each 10 g.l–1 decrease in haemoglobin at hospital discharge was associated with a 9% (hazard ratio 1.09, 95%CI 1.02–1.18; p = 0.014) and 8% increase (hazard ratio 1.08, 95%CI 1.06–1.11; p |
| doi_str_mv | 10.1111/anae.15859 |
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Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post‐hospitalisation outcomes, with a primary outcome of 30 day unanticipated hospital readmissions. This investigation includes data from two independent population‐based observational cohorts of adult surgical patients (aged ≥ 18 years) requiring postoperative intensive care unit admission between 1 January 2010 and 31 December 2019 in hospitals in Olmsted County, Minnesota, and between 1 July 2010 and 30 June 2017 in the Kaiser Permanente Northern California integrated healthcare system, California. Cox proportional hazards models assessed the associations between discharge haemoglobin concentrations (per 10 g.l–1) and outcomes, with prespecified multivariable adjustment. A total of 3260 patients were included from Olmsted County hospitals and 29,452 from Kaiser Permanente Northern California. In adjusted analyses, each 10 g.l–1 decrease in haemoglobin at hospital discharge was associated with a 9% (hazard ratio 1.09, 95%CI 1.02–1.18; p = 0.014) and 8% increase (hazard ratio 1.08, 95%CI 1.06–1.11; p < 0.001) in the hazard for readmission within 30 days in Olmsted County and Kaiser Permanente Northern California, respectively. In a sensitivity analysis exploring relationships across varying levels of pre‐operative anaemia severity, these associations remained consistent, with lower discharge haemoglobin concentrations associated with higher readmissions irrespective of pre‐operative anaemia severity. Anaemia at hospital discharge in surgical patients requiring postoperative intensive care is associated with increased rates of hospital readmission in two large independent cohorts. Future studies are necessary to evaluate strategies to prevent and/or treat anaemia in these patients for the improvement of post‐hospitalisation outcomes.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.15859</identifier><identifier>PMID: 36074010</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>anaemia ; Anemia ; Anemia - epidemiology ; Anemia - therapy ; Critical Care ; critical illness ; haemoglobin ; Hazard assessment ; Health hazards ; Hemoglobin ; Hemoglobins ; Hospitalization ; Hospitals ; Humans ; Intensive care ; Patient Readmission ; Patients ; Postoperative Care ; Postoperative period ; pre‐operative anaemia ; readmission ; Sensitivity analysis ; Statistical models ; Surgery ; Surgical Procedures, Operative - adverse effects ; transfusion</subject><ispartof>Anaesthesia, 2023-01, Vol.78 (1), p.45-54</ispartof><rights>2022 Association of Anaesthetists.</rights><rights>Copyright © 2023 Association of Anaesthetists</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4489-b7bb991dae5a24a53f2445f27d983303065dc4df1e342b169c9525370cb09653</citedby><cites>FETCH-LOGICAL-c4489-b7bb991dae5a24a53f2445f27d983303065dc4df1e342b169c9525370cb09653</cites><orcidid>0000-0002-6625-8755</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.15859$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.15859$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36074010$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Warner, M. A.</creatorcontrib><creatorcontrib>Hanson, A. C.</creatorcontrib><creatorcontrib>Plimier, C.</creatorcontrib><creatorcontrib>Lee, C.</creatorcontrib><creatorcontrib>Liu, V. X.</creatorcontrib><creatorcontrib>Richards, T.</creatorcontrib><creatorcontrib>Kor, D. J.</creatorcontrib><creatorcontrib>Roubinian, N. H.</creatorcontrib><title>Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post‐hospitalisation outcomes, with a primary outcome of 30 day unanticipated hospital readmissions. This investigation includes data from two independent population‐based observational cohorts of adult surgical patients (aged ≥ 18 years) requiring postoperative intensive care unit admission between 1 January 2010 and 31 December 2019 in hospitals in Olmsted County, Minnesota, and between 1 July 2010 and 30 June 2017 in the Kaiser Permanente Northern California integrated healthcare system, California. Cox proportional hazards models assessed the associations between discharge haemoglobin concentrations (per 10 g.l–1) and outcomes, with prespecified multivariable adjustment. A total of 3260 patients were included from Olmsted County hospitals and 29,452 from Kaiser Permanente Northern California. In adjusted analyses, each 10 g.l–1 decrease in haemoglobin at hospital discharge was associated with a 9% (hazard ratio 1.09, 95%CI 1.02–1.18; p = 0.014) and 8% increase (hazard ratio 1.08, 95%CI 1.06–1.11; p < 0.001) in the hazard for readmission within 30 days in Olmsted County and Kaiser Permanente Northern California, respectively. In a sensitivity analysis exploring relationships across varying levels of pre‐operative anaemia severity, these associations remained consistent, with lower discharge haemoglobin concentrations associated with higher readmissions irrespective of pre‐operative anaemia severity. Anaemia at hospital discharge in surgical patients requiring postoperative intensive care is associated with increased rates of hospital readmission in two large independent cohorts. Future studies are necessary to evaluate strategies to prevent and/or treat anaemia in these patients for the improvement of post‐hospitalisation outcomes.</description><subject>anaemia</subject><subject>Anemia</subject><subject>Anemia - epidemiology</subject><subject>Anemia - therapy</subject><subject>Critical Care</subject><subject>critical illness</subject><subject>haemoglobin</subject><subject>Hazard assessment</subject><subject>Health hazards</subject><subject>Hemoglobin</subject><subject>Hemoglobins</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Patient Readmission</subject><subject>Patients</subject><subject>Postoperative Care</subject><subject>Postoperative period</subject><subject>pre‐operative anaemia</subject><subject>readmission</subject><subject>Sensitivity analysis</subject><subject>Statistical models</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - adverse effects</subject><subject>transfusion</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q3DAUhUVpSKbTbPoARdBNKTjVr21tCkNImkBoN9kLWb6eaLAlR7ITZtk3j9xJQ9tFtLlC-s7hSAehD5Sc0by-Gm_gjMpaqjdoRXkpC0aEeItWhBBeMEHUCXqX0o4QympaH6MTXpJKEEpW6NcmpWCdmVzwuIHpEcDjxXBwJs8W34U0usn0OIJpB5dSBhN2Ho9ZA35KePYtxG1wfosHswsRpzluIe6z4n52cTkfQ5rCCDFLHiCLJ_Bp2VkT4T066kyf4PR5rtHt5cXt-VVx8_P79fnmprBC1KpoqqZRirYGpGHCSN4xIWTHqlbVnBNOStla0XYUuGANLZVVkkleEdsQVUq-Rt8OtuPcDNDaHD2aXo_RDSbudTBO_3vj3Z3ehgetKsGoYNng87NBDPczpEnn37DQ98ZDmJNmFaW1EFyVGf30H7oLc_T5dZkSFeNiaWaNvhwoG0NKEbqXMJTopVi99KB_F5vhj3_Hf0H_NJkBegAeXQ_7V6z05sfm4mD6BLftsV4</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Warner, M. A.</creator><creator>Hanson, A. C.</creator><creator>Plimier, C.</creator><creator>Lee, C.</creator><creator>Liu, V. X.</creator><creator>Richards, T.</creator><creator>Kor, D. J.</creator><creator>Roubinian, N. H.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6625-8755</orcidid></search><sort><creationdate>202301</creationdate><title>Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care</title><author>Warner, M. A. ; Hanson, A. C. ; Plimier, C. ; Lee, C. ; Liu, V. X. ; Richards, T. ; Kor, D. J. ; Roubinian, N. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4489-b7bb991dae5a24a53f2445f27d983303065dc4df1e342b169c9525370cb09653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>anaemia</topic><topic>Anemia</topic><topic>Anemia - epidemiology</topic><topic>Anemia - therapy</topic><topic>Critical Care</topic><topic>critical illness</topic><topic>haemoglobin</topic><topic>Hazard assessment</topic><topic>Health hazards</topic><topic>Hemoglobin</topic><topic>Hemoglobins</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Patient Readmission</topic><topic>Patients</topic><topic>Postoperative Care</topic><topic>Postoperative period</topic><topic>pre‐operative anaemia</topic><topic>readmission</topic><topic>Sensitivity analysis</topic><topic>Statistical models</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - adverse effects</topic><topic>transfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Warner, M. A.</creatorcontrib><creatorcontrib>Hanson, A. C.</creatorcontrib><creatorcontrib>Plimier, C.</creatorcontrib><creatorcontrib>Lee, C.</creatorcontrib><creatorcontrib>Liu, V. X.</creatorcontrib><creatorcontrib>Richards, T.</creatorcontrib><creatorcontrib>Kor, D. J.</creatorcontrib><creatorcontrib>Roubinian, N. H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Warner, M. A.</au><au>Hanson, A. C.</au><au>Plimier, C.</au><au>Lee, C.</au><au>Liu, V. X.</au><au>Richards, T.</au><au>Kor, D. J.</au><au>Roubinian, N. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2023-01</date><risdate>2023</risdate><volume>78</volume><issue>1</issue><spage>45</spage><epage>54</epage><pages>45-54</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post‐hospitalisation outcomes, with a primary outcome of 30 day unanticipated hospital readmissions. This investigation includes data from two independent population‐based observational cohorts of adult surgical patients (aged ≥ 18 years) requiring postoperative intensive care unit admission between 1 January 2010 and 31 December 2019 in hospitals in Olmsted County, Minnesota, and between 1 July 2010 and 30 June 2017 in the Kaiser Permanente Northern California integrated healthcare system, California. Cox proportional hazards models assessed the associations between discharge haemoglobin concentrations (per 10 g.l–1) and outcomes, with prespecified multivariable adjustment. A total of 3260 patients were included from Olmsted County hospitals and 29,452 from Kaiser Permanente Northern California. In adjusted analyses, each 10 g.l–1 decrease in haemoglobin at hospital discharge was associated with a 9% (hazard ratio 1.09, 95%CI 1.02–1.18; p = 0.014) and 8% increase (hazard ratio 1.08, 95%CI 1.06–1.11; p < 0.001) in the hazard for readmission within 30 days in Olmsted County and Kaiser Permanente Northern California, respectively. In a sensitivity analysis exploring relationships across varying levels of pre‐operative anaemia severity, these associations remained consistent, with lower discharge haemoglobin concentrations associated with higher readmissions irrespective of pre‐operative anaemia severity. Anaemia at hospital discharge in surgical patients requiring postoperative intensive care is associated with increased rates of hospital readmission in two large independent cohorts. Future studies are necessary to evaluate strategies to prevent and/or treat anaemia in these patients for the improvement of post‐hospitalisation outcomes.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>36074010</pmid><doi>10.1111/anae.15859</doi><tpages>54</tpages><orcidid>https://orcid.org/0000-0002-6625-8755</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | anaemia Anemia Anemia - epidemiology Anemia - therapy Critical Care critical illness haemoglobin Hazard assessment Health hazards Hemoglobin Hemoglobins Hospitalization Hospitals Humans Intensive care Patient Readmission Patients Postoperative Care Postoperative period pre‐operative anaemia readmission Sensitivity analysis Statistical models Surgery Surgical Procedures, Operative - adverse effects transfusion |
| title | Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care |
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