Readmission and mortality outcomes with subsequent follow-up hemoglobin checks in general medical patients with hospital-acquired anemia.

Abstract

Introduction: Hospital-acquired anemia is associated with increased readmissions and 30-day mortality. We evaluated whether anemia severity is associated with readmission and mortality 1-year post-hospitalization, and whether a recheck of hemoglobin and/or hematocrit level within 30 days of discharge is associated with reduced readmission and mortality rates.

Methods: A retrospective cohort study was conducted on 1734 patients at the Mayo Clinic Hospital Inpatient services from 2020 to 2023. The association between readmission and death within 1 year, and hemoglobin recheck within 30 days, or anemic category, was assessed using multivariable Cox regression while controlling for patient characteristics.

Results: There were 1734 patients meeting inclusion criteria (mean age 61.5 years). Prior to discharge, 89.4% of the patients remained anemic, categorized as mild (53%), moderate (39.1%), or severe (7.8%) anemia. Only 526 (30.3%) had a hemoglobin recheck within 30 days of discharge. Anemia severity at discharge was not associated with readmission or mortality. Age, length of stay, and a higher hemoglobin level prior to discharge were significantly associated with readmission and mortality risk. A hemoglobin recheck within 30 days post-discharge was associated with a higher risk of 30-day readmission and subsequent mortality (HR = 5.97, p < 0.001; HR = 1.69, p = 0.006).

Conclusion: Patients with more severe hospital-acquired anemia did not have increased readmission and mortality during 1-year post-hospitalization. Anemia rechecking was associated with increased mortality but likely confounded by underlying co-morbidities and other clinical factors. Future studies could compare readmission and mortality in different discharge destinations.