title: Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate.
abstract: OBJECTIVE
  Anemia, either chronic or newly developed in the hospital as a result of underlying disease and/or phlebotomy, is seen commonly among general medical inpatients, and its impact on the quality and efficiency of care is unknown.
  
  
  METHODS
  This study investigated the relation among hemoglobin level, length of stay, and 30-day unplanned readmission rates in a cohort of 314 general medical inpatients 18 years old and older admitted to a teaching hospital during a period of 4 months in a large urban academic medical center, using retrospective chart review of the electronic health record.
  
  
  RESULTS
  Anemia was common among this cohort of general medical inpatients (44.6%), and there was a statistically significant decrease in hemoglobin levels during their hospitalization. Anemic patients, as compared with nonanemic patients, had significantly longer mean and median length of stay. More important, the admission hemoglobin level and its change during hospitalization were significant predictors of increased length of stay. For every 1-U increase in admission hemoglobin level, the median length of stay was reduced by 0.5 days. For every 1-U increase in the level of hemoglobin change, the median length of stay was extended by 1.5 days. Likewise, the discharge hemoglobin level predicted the rate of 30-day unplanned readmission. For every 1-U decrease in discharge hemoglobin level, the readmission rate increased by nearly 4%. These relations remained after adjusting for common demographic and clinical variables, including age, sex, nutritional status, and number of comorbidities.
  
  
  CONCLUSIONS
  Anemia is common among general medical inpatients and adversely affects their length of stay and 30-day unplanned readmission rate.
authors: Department of Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, New York 10065, USA. ril9016@med.cornell.edu
authors: Richard J
authors: RJ
authors: Lin
authors: Arthur T
authors: AT
authors: Evans
authors: Amy E
authors: AE
authors: Chused
authors: Michelle E
authors: ME
authors: Unterbrink
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins
references: Ann Intern Med. 2012 Jul 3;157(1):49-58
references: 22751760
references: Am J Cardiol. 2008 Jan 15;101(2):223-30
references: 18178411
references: Am J Health Syst Pharm. 2007 Aug 15;64(16 Suppl 11):S3-10
references: 17687068
references: Gerontology. 2006;52(6):382-5
references: 16914932
references: Gut. 2011 Oct;60(10):1309-16
references: 21561874
references: N Engl J Med. 2009 Dec 17;361(25):2436-48
references: 19920054
references: JAMA. 2011 Oct 19;306(15):1688-98
references: 22009101
references: J Gen Intern Med. 2005 Jun;20(6):520-4
references: 15987327
references: Intern Med J. 2012 Jun;42(6):683-91
references: 21790925
references: Am Fam Physician. 2010 Sep 1;82(5):480-7
references: 20822082
references: J Hosp Med. 2010 May-Jun;5(5):283-8
references: 20533576
references: Lancet. 2007 Feb 3;369(9559):381-8
references: 17276778
references: Arch Intern Med. 2011 Oct 10;171(18):1646-53
references: 21824940
references: J Am Med Dir Assoc. 2006 Jun;7(5):287-93
references: 16765864
references: N Engl J Med. 2009 Apr 2;360(14):1418-28
references: 19339721