Does anemia impact hospital readmissions after coronary artery bypass surgery?

Authors

  • Nadine Shehata,

    Corresponding author
    1. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    2. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    3. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    5. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    6. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    7. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    8. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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  • Alan Forster,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Le Li,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Deanna M. Rothwell,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • C. David Mazer,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Gary Naglie,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Robert Fowler,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Jack V. Tu,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Fraser D. Rubens,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Steven Hawken,

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Kumanan Wilson

    1. Department of Medicine, Institute of Health Policy Management and Evaluation, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
    2. Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    3. Central Ontario Region, Canadian Blood Services, Toronto, Ontario, Canada
    4. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    6. Department of Medicine, University of Ottawa, Toronto, Ontario, Canada
    7. Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
    8. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    9. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    Search for more papers by this author

  • Funded by a Canadian Blood Services’ intramural grant (XT0085), Canada.
  • NS is a consultant for Canadian Blood Services. Canadian Blood Services did not have a role in the design, analysis, or interpretation of the results.
  • [Correction added after online publication 11-Dec-2012: the spelling of Hawken has been updated.]

Address reprint requests to: Nadine Shehata, MD, Mount Sinai Hospital, 6-502-5, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5; e-mail: nshehata@mtsinai.on.ca.

Abstract

Background

Anemia is one of the most common complications of coronary artery bypass graft (CABG) surgery and has been shown to be associated with increased morbidity and mortality. The impact of anemia on hospital readmission after CABG, a potential measure of delayed complications, has not been addressed.

Study Design and Methods

We conducted a single-center retrospective study of 2102 patients who had CABG in Ontario to determine whether anemia at hospital discharge was associated with increased 30-day hospital readmissions, readmission secondary to cardiac disease, and 30-day mortality using administrative data.

Results

Of the 2102 patients, 224 patients (11%) were readmitted within 30 days of hospital discharge. Infection was the leading cause of readmissions (24%), followed by heart failure (13%), pulmonary disease (7%), and hemorrhagic disease (7%). Overall, 2.6% of patients were readmitted because of cardiac disease. Of patients discharged, 48% were discharged with a hemoglobin (Hb) level between 8 and 10 g/dL and 42% between 10 and 12 g/dL. Predischarge Hb concentration was not a significant independent predictor of 30-day readmission to the hospital due to all causes, readmission to the hospital due to cardiac causes, or 30-day mortality. A higher comorbidity score, adjusted odds ratio (OR) of 2.1 (95% confidence interval [CI], 1.3-3.6), leg and sternal wound infections OR of 1.9 (95% CI, 1.2-3.0), and postoperative renal failure OR of 1.4 (95% CI, 1.2-2.0) were associated with increased 30-day readmission rates.

Conclusions

The predischarge Hb concentration after CABG was not associated with 30-day readmissions.

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