Multiple Readmissions Research Articles

Readmissions After Lung Transplantation.

Lung transplantation has evolved to become an acceptable therapy for individuals with end-stage lung disease. Readmissions rates after lung transplantation remain high as compared to other medical surgical populations. The purpose of this review is to synthesize the current body of knowledge about patterns, risk factors, and outcomes of readmissions after lung transplantation. The literature revealed that the most common admission diagnoses linked to lung transplant readmissions are infections followed by tachyarrhythmias, airway complications, surgical complications, rejection, thromboembolic events, gastrointestinal complications, and renal dysfunction. Risk factors for these readmissions include male gender, longer intensive care unit stay, reintubation, prolonged chest tube air leak, frailty, and discharge to a long-term care facility. Outcomes of multiple readmissions after lung transplantation are associated with decreased survival and increased risk of mortality. Further research is needed to better understand which readmission diagnoses are preventable and whether multidisciplinary interventions can reduce readmission rates among patients after lung transplantation.

Variance estimation in inverse probability weighted Cox models.

Inverse probability weighted Cox models can be used to estimate marginal hazard ratios under different point treatments in observational studies. To obtain variance estimates, the robust sandwich variance estimator is often recommended to account for the induced correlation among weighted observations. However, this estimator does not incorporate the uncertainty in estimating the weights and tends to overestimate the variance, leading to inefficient inference. Here we propose a new variance estimator that combines the estimation procedures for the hazard ratio and weights using stacked estimating equations, with additional adjustments for the sum of terms that are not independently and identically distributed in a Cox partial likelihood score equation. We prove analytically that the robust sandwich variance estimator is conservative and establish the asymptotic equivalence between the proposed variance estimator and one obtained through linearization by Hajage etal. in 2018. In addition, we extend our proposed variance estimator to accommodate clustered data. We compare the finite sample performance of the proposed method with alternative methods through simulation studies. We illustrate these different variance methods in both independent and clustered data settings, using a bariatric surgery dataset and a multiple readmission dataset, respectively. To facilitate implementation of the proposed method, we have developed an package ipwCoxCSV.

Homeless Shelter Flows in Calgary and the Potential Impact of COVID-19.

Social distancing and self-isolation are two of the key responses asked of citizens during a pandemic. For people without a home, this advice is rather more difficult to follow. In this article, we use daily data describing the movements of 36,855 unique individuals who used emergency homeless shelters in Calgary over the period 1 January 2014–31 December 2019. We show that the use of emergency shelters is characterized by large flows from and into the broader community and smaller flows between individual shelters. Between admissions of new people into the shelter system and multiple re-admissions of current clients, there were an average of 43,613 movements between the community and between shelters each month. The size of these flows provide a measure of the extent to which people reliant on homeless shelters are exposed to the risk of transmission of coronavirus disease 2019 (COVID-19). By identifying the size and nature of these flows, we hope our analysis helps identify responses that may minimize this population’s risk of exposure.

Colonic perforation due to inadvertent intraperitoneal LVAD driveline placement

BackgroundLeft ventricular assist devices (LVAD) are placed for patients with advanced heart failure or cardiogenic shock as destination therapy or as a bridge to cardiac transplantation. Significant complications associated with LVAD placement include bleeding, infection, pump thrombosis, right heart failure, device malfunction and stroke. The case below illustrates inadvertent intraperitoneal driveline placement causing colonic perforation and the subsequent management.Case presentationA 54 year old male with a history of Wolff-Parkinson-White syndrome resulting in multiple readmissions for heart failure, ultimately required placement of a left ventricular assist device (LVAD). Several weeks later, he was found to have stool draining from the driveline site. The patient was taken to the operating room for limited exploration by the Cardiothoracic Surgery team and a bowel injury was identified and repaired. Three days after this repair, stool was once again leaking from the driveline site, requiring re-exploration by the Acute Care Surgery team. Intraoperatively, the prior repair was found to be leaking and multiple intra-abdominal abscesses were discovered. The transverse colon was resected and left in discontinuity. On a planned second look operation, the LVAD driveline was relocated to be extra-peritoneal and a colostomy was formed.Discussion and conclusionThis case demonstrates the importance of early recognition and involvement of an Acute Care Surgeon in the management of this complex problem. Appropriate treatment involves a complete exploration, source control, driveline relocation and possible fecal diversion. Although the incidence of this complication is low, it must be considered in the differential in a septic LVAD patient.

Life after hospital discharge for people with long-term mental disorders in South Korea: Focusing on the "revolving door phenomenon".

The purpose of this study was to explore the lives of Koreans with long-term mental disorders who had experienced multiple readmissions after hospital discharges. In-depth interviews were conducted with 11 participants and thematic analysis was used to examine their data. Four themes emerged from the data, describing their lives: they suffered in the aspects of social maladjustment, loneliness, causing shame to their families, and managing mental illnesses. After patients with mental disorders are discharged from the hospital, they need transitional care before systematic community-based care to enhance their autonomy and reduce the burden on their families.

Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement.

Heart failure (HF) readmission is common post-transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death. Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99-1.85]). However, late (HR, 1.90 [95% CI, 1.30-2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17-3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48-0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37-0.98]) of the optimal daily dose. HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.

A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic

Background There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes. Objective To assess the impact of a post-discharge, pharmacist-led medicines optimisation clinic on readmission parameters. Assessment of the economic, clinical and humanistic outcomes were considered. Setting Respiratory and cardiology wards in a district general hospital in Northern Ireland. Method Randomised, controlled trial. Blinded random sequence generation; a closed envelope-based system, with block randomisation. Adult patients with acute unplanned admission to medical wards subject to inclusion criteria were invited to attend clinic. Analysis was carried out for intention-to-treat and per-protocol perspectives. Main Outcome Measure 30-day readmission rate. Results Readmission rate reduction at 30 days was 9.6% (P = 0.42) and the reduction in multiple readmissions over 180-days was 29.1% (P = 0.003) for the intention-to-treat group (n = 31) compared to the control group (n = 31). Incidence rate ratio for control patients for emergency department visits was 1.65 (95% CI 1.05–2.57, P = 0.029) compared with the intention-to-treat group. For unplanned GP consultations the equivalent incident rate ratio was 2.00 (95% CI 1.18–3.58, P = 0.02). Benefit to cost ratio in the intention-to-treat and per-protocol groups was 20.72 and 21.85 respectively. Patient Health Related Quality of Life was significantly higher at 30-day (P < 0.001), 90-day (P < 0.001) and 180-day (P = 0.036) time points. A positive impact was also demonstrated in relation to patient beliefs about their medicines and medication adherence. Conclusion A pharmacist-led post-discharge medicines optimisation clinic was beneficial from a patient care and cost perspective.

Palliative Care Consultation Reduces Heart Failure Transitions: A Matched Analysis.

BackgroundPalliative care supports quality of life, symptom control, and goal setting in heart failure (HF) patients. Unlike hospice, palliative care does not restrict life‐prolonging therapy. This study examined the association between palliative care during hospitalization for HF on the subsequent transitions and procedures.Methods and ResultsVeterans admitted to hospitals with HF from 2010 to 2015 were randomly selected for the Veterans Administration External Peer Review Program. Variables pertaining to demographic, clinical, laboratory, and usage were captured from Veterans Administration electronic records. Patients receiving hospice services before admission were excluded. Patients who received palliative care were propensity matched to those who did not. The primary outcomes were whether the patient experienced transitions or procedures in the 6 months after admission. Transitions included multiple readmissions (≥2) or intensive care admissions and procedures included mechanical ventilation, pacemaker implantation, or defibrillator implantation. Among 57 182 hospitalized HF patients, 1431 received palliative care, and were well matched to 1431 without (standardized mean differences ≤ ±0.05 on all matched variables). Palliative care was associated with significantly fewer multiple rehospitalizations (30.9% versus 40.3%, P<0.001), mechanical ventilation (2.8% versus 5.4%, P=0.004), and defibrillator implantation (2.1% versus 3.6%, P=0.01). After adjustment for facility fixed effects, palliative care consultation was associated with a significantly reduced hazard of multiple readmissions (adjusted hazard ratio=0.73, 95% CI, 0.64–0.84) and mechanical ventilation (adjusted hazard ratio=0.76, 95% CI, 0.67–0.87).ConclusionsPalliative care during HF admissions was associated with fewer readmissions and less mechanical ventilation. When available, engagement of HF patients and caregivers in palliative care for symptom control, quality of life, and goals of care discussions may be associated with reduced rehospitalizations and mechanical ventilation.

The impact of global budget on expenditure, service volume, and quality of care among patients with pneumonia in a secondary hospital in China: a retrospective study

BackgroundThe Chinese government has begun to dampen the growth of health expenditure by implementing Global Budgets (GB). Concerns were raised about whether reductions in expenditure would lead to a deterioration of quality of care. This paper aims to evaluate the impact of GB on health expenditure, service volume and quality of care among Chinese pneumonia patients.MethodsA secondary hospital that replaced Fee-For-Service (FFS) with GB in China in 2016 was sampled. We used daily expenditure to assess health expenditure; monthly admission, length of stay (LOS), number of drugs per record and record containing antibiotics to evaluate service volume; record with multiple antibiotics and readmission to assess quality of care. Descriptive analyses were adopted to evaluate changes after the reform, logistic regression and multivariable linear regressions were used to analyze changes associated with the reform.ResultsIn 2015 and 2016, 3400 admissions from 3173 inpatients and 2342 admissions from 2246 inpatients were admitted, respectively. According to regression analyses, daily expenditure, LOS, readmission, and records with multiple antibiotic usages significantly declined after the reform. However, no significant relation was observed between GB and the number of drugs per record or record containing antibiotics.ConclusionsWhen compared with FFS, GB can curtail health expenditure and improve quality of care. As far as service volume was concerned, LOS and monthly admission declined, while number of drugs per record and record containing antibiotics were not affected.

Incidence and Cause of Persistent Low Flow Alarm after HeartMate 3 Left Ventricular Assist Device Insertion

This study sought to determine the incidence and cause of readmission due to persistent low flow alarms after HM3 LVAD implantation. We retrospectively reviewed 135 patients who received HM3 LVAD between November 2014 and December 2018 in our single center. Patients who required readmission due to persistent low flow alarms were identified and analyzed. Cumulative incidence function curve was constructed for probability of low flow alarm readmission. Twenty-three patients (17.4%) required 28 readmissions due to persistent low flow alarms during median follow up of 11.2 months. The incidence of readmissions with persistent low flow alarms was 1.31 person-years. The probability of low flow alarm readmission was 17.7% at 1-year. Of 23 patients, 4 patients (17.4%) required multiple readmissions. The etiology of persistent low flow alarms is summarized in Table: Hypovolemia was present in 11 (39.3%) and hypertension was present in 16 (17.8%). Inflow or outflow obstruction requiring surgical intervention was present in 5 (17.8%). The reason for the alarm was not identified in 5 patients (17.8%). No patients had an electrical issue with the pump or a driveline disruption identified. Readmission due to low flow alarms is relatively common after HM3 LVAD. Hypovolemia was the most frequent etiology of low flow alarms. Obstruction of the inflow cannula or outflow graft is a serious complication that can present with low flow alarms and requires reoperation.

Hospital Readmissions After Laboratory-Confirmed Influenza Hospitalization.

Influenza infection causes substantial morbidity and mortality. However, little is known about hospital readmissions after an influenza hospitalization. The aim of our study was to characterize frequency of hospital readmissions among patients hospitalized with laboratory-confirmed influenza. We conducted a retrospective study using Tennessee Emerging Infections Program Influenza Surveillance data from 2006 to 2016 and the concurrent Tennessee Hospital Discharge Data System. We analyzed demographic characteristics and outcomes to better understand frequency and factors associated with hospital readmissions. Of the 2897 patients with a laboratory-confirmed influenza hospitalization, 409 (14%) and 1364 (47%) had at least 1 hospital readmission within 30 days and 1 year of the influenza hospitalization, respectively. Multiple readmissions occurred in 739 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not hospitalized. Pneumonia, acute chronic obstructive pulmonary disease/asthma exacerbation, septicemia, acute respiratory failure, and acute renal failure were the most common causes for readmission at 30 days. Underlying cardiovascular disease, lung disease, kidney disease, diabetes, immunosuppression, and liver disease were associated with increased risk of readmission during the subsequent year. After an admission with laboratory-confirmed influenza, there is a high likelihood of readmission within 30 days and 1 year adding to the morbidity of influenza.

Do the uninsured demand less care? Evidence from Maryland's hospitals.

Uninsured individuals receive fewer healthcare services for at least three reasons: responsibility for the entire bill, higher prices, and potential provider reductions for concern of nonpayment. I isolate reductions when uninsured patients are solely financially responsible by capitalizing on Maryland's highly regulated health care system. Prices are set by the state, are uniform across all patients, and hospitals are compensated for free care and bad debt. I use a unique feature of the data, multiple readmissions for patients who gain or lose insurance between visits, to isolate the reductions in quantity demanded when individuals are faced with paying the full price without an insurance contribution. A Blinder-Oaxaca decomposition estimates uninsured individuals receive 6% fewer services after accounting for differences in patient, illness, and hospital characteristics than when these same individuals are insured.

Multiple unplanned readmissions after discharge for an admission with percutaneous coronary intervention.

This study aims to describe temporal trends, characteristics, and clinical outcomes of patients with more than one unplanned readmission within 30 and 180 days after admission with percutaneous coronary intervention (PCI). There is limited understanding of multiple readmissions after PCI. Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 and 180 days after discharge. Trends in multiple readmissions, characteristics of patients, and causes of first readmissions are described. A total of 2,324,194 patients were included in the analysis of 30-day unplanned readmissions and 1,327,799 patients in the analysis of 180-day unplanned readmission. The proportions of patients with a single readmission and multiple readmissions within 30 days were 8.5 and 1.0% and at 180 days were 15.4 and 9.1%, respectively. Common reasons for first readmission among patients with multiple readmissions were coronary artery disease, including angina, heart failure, and acute myocardial infarction. Factors associated with multiple readmissions were discharge against medical advice, discharge to care home, renal failure, and liver failure. The total cost of multiple readmissions is significant, with an increase from ~$20,000 for no readmission to over $60,000 at 30-day follow up and $86,000 at 180-day follow up. Multiple readmissions are rare within 30 days after PCI but increase to nearly 1 in 10 patients at 180 days, and 20-25% of patients who have multiple readmissions are readmitted for the same cause as for the first and second readmissions.

Incidence of and Risk Factors for Multiple Readmissions after Kidney Transplantation

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.

Now is the time for the Organ Procurement and Transplantation Network to change regulatory policy to effectively increase transplantation in the United States; Carpe Diem.

With the Centers for Medicare and Medicaid Services proposing to remove outcome measures from the transplant centers' renewal for Conditions of Participation an exciting opportunity surfaces for the Organ Procurement and Transplantation Network to make an equally bold change and allow for increased transplantation options for patients in the United States.

Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data.

Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database. We retrospectively queried the 2010-2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses. The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings. Analysis of national data demonstrates an increasing trend of MO patients' admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.

Persistent cough: An unexpected diagnosis

Esophageal cancer is the eighth most common cancer and the sixth most common cause of cancer death globally. Esophageal squamous cell carcinoma (ESCC) accounts for 70%–90% of esophageal cancers worldwide, 5% are adenocarcinoma, and 5% represent rare malignancies and metastases from other organs. We present a case where a 54-year-old lady, with multiple readmissions for persistent dry cough and respiratory symptoms, turns out to be an esophageal malignancy. CECT thorax revealed an enhancing wall thickening of the esophagus with paraoesophageal fat stranding, mediastinal lymphadenopathy, and subsegmental right lobe atelectasis, suggestive of a probable esophageal malignancy. An upper gastrointestinal endoscopy showed a circumferential esophageal growth which on biopsy and histopathological examination turned out to be a moderately differentiated squamous cell carcinoma of esophagus.

The Effect of Glycemic Control on Cardiac Outcomes in Saudi Diabetic Patients who Underwent Coronary Angiogram.

Background:Diabetes mellitus is a metabolic disorder that causes impaired insulin secretion or cellular dysfunction. Glycated hemoglobin (HbA1c) indicates the long-term level of glucose. Diabetes can lead to cardiovascular complications such as acute coronary syndrome , which might require coronary intervention.Objectives:The aim of this study was to estimate the effect of glycemic control measured by HbA1c levels on cardiac complications in Saudi diabetic patients who underwent percutaneous coronary intervention (PCI) or Coronary artery bypass graft (CABG).Methodology:It was a cohort retrospective study conducted at King Abdulaziz Cardiac Center with a total sample size of 379 patients. The charts of all those diabetic patients were reviewed and their HbA1c level, type of intervention were compared to determine their effect on cardiac outcomes and complications. Inclusion criteria involved the age group 50–70 years within follow-up period of 3 years. Any patient known to have renal failure, liver dysfunction, type one diabetes, and cancer were excluded. The HbA1c level was divided into two groups (<7.5%, ≥7.5%).Results:Total sample size was 379, and the mean age was (60.33 ± 5.98) with male being (66.5%). HbA1c levels at admission were (mean 9.15 ± 2.03), whereas the mean after 3 years was (8.629 ± 1.518). The uncontrolled group was more likely to have PCI (n = 302), in comparison to the controlled group (n = 77) with a P value of 0.04. However, the controlled group was more likely to undergo medical treatment P value of 0.001. Patients with uncontrolled Hba1c after the intervention had a higher readmission rate with a P value of 0.018.Conclusions:Patients with an elevated level of HbA1c were more likely to be managed with PCI. Furthermore, they are at a higher risk of multiple readmissions. Patients who had CABG were at a lower risk of cardiac complications. Further studies are required in our population to consider different approaches of diabetes control for preventing adverse outcomes.

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis.

This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphadenitis between 2013 and 2017. Children with complex chronic conditions, transferred from another institution, and with prior hospitalizations for lymphadenitis were excluded. To examine hospital-level variation, we calculated the proportion of children at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. Generalized linear or logistic mixed effects models examined the association between early imaging and outcomes (ie, multiple imaging studies, surgical drainage, 30-day readmission, and length of stay) while accounting for patient demographics, markers of illness duration and severity, and clustering by hospital. Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging presented increased odds of having multiple imaging studies (adjusted odds ratio [aOR] 3.0; 95% CI: 2.6-3.6), surgical drainage (aOR 1.3, 95%CI: 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95%CI: 1.2-1.9), as well as longer lengths of stay (adjusted rate ratio 1.2, 95%CI: 1.1-1.2). Children receiving early imaging had more resource utilization and intervention than those without early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue additional testing and interventions in this population.

Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda

Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda Ruth Namazzi, Andrea Conroy, Dibyadyuti Datta, Gloria Kyarisiima Chandy John, Robert Opoka Background Children with severe malaria anaemia are at an increased risk of poor post discharge outcomes including frequent readmissions and clinic visits for malaria. How the post-discharge outcomes affect haematological recovery of children after severe malaria anaemia has not been evaluated. Methods We enrolled and followed up for 12 months 248 children with severe malaria anaemia (SMA) and 120 age matched asymptomatic community controls (CC). Complete blood counts, reticulocyte percentages and erythropoietin levels were done at baseline, 1 month and 12 months after the malaria episode. Children were treated according to national guidelines, which included blood transfusion and anti malarial therapy. We evaluated the relationship between recovery of haematological indices and multiple readmissions in the post-discharge period in SMA children. Results The mean age was 2.12 ± 0.9 and 2.2 ± 1.0 years (p=0.266) for SMA and CC respectively. The mean baseline haemoglobin (Hb), reticulocyte percentage and erythropoietin levels were 3.5 ± 0.9g/dL, 2.6±4.7% and 6843±5891 for SMA, compared to 10.8±1.5g/dL, 1.8±2.6% and 58.5 for CC, respectively. By 1-month, SMA children had made complete haematological recovery with mean Hb, reticulocyte percentage and erythropoietin levels of 11.2 ± 2.2g/dL, 1.8± 2.7% and 20.2 ± 58.3. The hematological recovery was sustained even by month12 follow up; mean Hb level was 10.7±2.1 and 11.6±2.1g/dL for SMA and CC, p =0.07. Reticulocyte percentages were comparable between SMA and CC, 2.5 ± 4.1vs 1.2±1.7,p=0.41. Amongst SMA group, more children who had multiple readmissions during the follow up period were still anemic at 12 months compared to those who did not have multiple readmissions, 7/64(10.9%) vs. 13/168(7.8%). The difference however was not statistically significant (p=0.438). Conclusion Children with SMA achieve hematological recovery by 1 month post-discharge. The hematological recovery was maintained until 12 months post-discharge. Amongst SMA children, multiple readmissions in the post-discharge period did not appear to adversely affect hematological recovery by 12 months. The effect of repeated malaria episodes on long term haematological recovery needs further study. Disclosures Conroy: ALC: Patents &amp; Royalties: angiopoietin-1, angiopoietin-2.