Early Readmission to Hospital in Patients With Cancer With Malignant Pleural Effusions

Mitchell, M. A.; Dhaliwal, Inderdeep; Mulpuru, Sunita; Amjadi, Kayvan; Chee, Alex

doi:10.1016/j.chest.2019.09.007

Cited by 20 publications

(14 citation statements)

References 37 publications

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“…Readmission was defined as diagnoses with CML and unplanned hospital readmissions from the discharge, and we only recorded the first readmission for patients with multiple readmissions. 17 The NR/relapse in patients with CML was diagnosed by using ICD‐10‐CM. Severe mortality risk was defined as the major likelihood of dying based on the risk‐of‐mortality subclass in the 2018 NRD database.…”

Section: Methodsmentioning

confidence: 99%

“…The primary outcome was the adverse outcomes (nonremission [NR]/relapse and severe mortality risk) in patients with CML on different readmission days. Readmission was defined as diagnoses with CML and unplanned hospital readmissions from the discharge, and we only recorded the first readmission for patients with multiple readmissions 17 . The NR/relapse in patients with CML was diagnosed by using ICD‐10‐CM.…”

Section: Methodsmentioning

confidence: 99%

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Association of obesity under different metabolic status with adverse outcomes in patients with chronic myeloid leukemia: A retrospective cohort study

Dong

Cheng

Feng

et al. 2023

Journal of Diabetes

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Background Little is known about the association between abnormal metabolic obesity states and the outcomes of chronic myeloid leukemia (CML), especially in patients with obesity with different metabolic status. Here, we used the Nationwide Readmissions Database to assess the effects of metabolically defined obesity on adverse outcomes of CML. Methods Of the 35 460 557 (weighted) patients, we included 7931 adults with discharge diagnoses of CML from January 1, 2018 to June 30, 2018. The study population was observed until December 31, 2018 and divided into four groups based on body mass index and metabolic status. The primary outcome was the adverse outcomes of CML, including nonremission (NR)/relapse and severe mortality risk. Multivariate logistic regression analysis was performed to analyze data. Results Metabolically unhealthy normal weight and metabolically unhealthy obesity were all risk factors for adverse outcomes of CML compared with metabolically healthy normal weight (all p < 0.01), and a significant difference was not found in the metabolically healthy obese. Female patients with metabolically unhealthy normal weight and metabolically unhealthy obesity had 1.23‐fold and 1.40‐fold increased NR/relapse risk, while male patients did not have this risk. Moreover, patients with a higher number of metabolic risk factors or with dyslipidemia were at higher risk of adverse outcomes, regardless of obesity status. Conclusions Metabolic abnormalities were associated with adverse outcomes in patients with CML, irrespective of obesity status. Future treatment of patients with CML should consider the effects of obesity on their adverse outcomes under different metabolic status, especially in female patients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of obesity under different metabolic status with adverse outcomes in patients with chronic myeloid leukemia: A retrospective cohort study

Dong

Cheng

Feng

et al. 2023

Journal of Diabetes

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“…Chest tubes are placed to drain the effusions in 31.9% of patients during hospitalization ( Fortin et al, 2018 ); however, we are not able to determine how many were IPCs established for home drainage. A second study based on 2014 data from 108,824 patients with MPE admitted to hospitals reported a 25.6% readmission rate with a total cost of over $400 million ( Mitchell et al, 2020 ). Home health and hospice care can be provided at markedly reduced costs.…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%

Indwelling Pleural Catheters for Malignant Pleural Effusion

Vrtis

DeCesare

Day

2021

Home Healthcare Now

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Malignant pleural effusion (MPE) resulting from metastatic spread to the pleura frequently occurs in patients with primary lung, breast, hematological, gastrointestinal, and gynecological cancers. These effusions tend to reaccumulate quickly, and the patient requires increasingly frequent thoracentesis. An indwelling pleural catheter allows for dramatic improvement in quality of life as the patient has the power to ease her/his own suffering by draining the effusion at home when shortness of breath and/or chest pain intensifies. Patients with MPE need home healthcare support to address symptom management related to complications of advanced metastatic cancer and antineoplasm treatment regimens. The financial obstacles for the home healthcare agency are explored by using agency supply costs, per visit costs, and the patient-driven groupings reimbursement mode grouper to estimate reimbursement. Care for a home healthcare patient with MPE costs Medicare approximately $64.50 per day, markedly less than costs for hospitalization and outpatient thoracentesis. Unfortunately, agencies must absorb the cost of vacuum drainage bottles. Whereas a small positive balance of $291 was estimated for the first 30-day posthospital episode, losses were estimated at $1,185 to $1,633 for subsequent 30-day episodes. Absorbing these costs has become extremely difficult as home healthcare agencies are experiencing unprecedented COVID-19 infection control and staffing-related costs.

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“…American and European guidelines have recommended both as first-line interventions for the palliation of recurrent MPE following an initial thoracentesis 9,10. Despite compelling evidence, many patients with MPE face delays in accessing definitive palliative procedures, undergo multiple nondefinitive procedures, and go through potentially avoidable hospital admissions 11–14. Audits of national cancer databases have shown that only 24% of MPE patients receive guideline-consistent care 12.…”

mentioning

confidence: 99%

“…9,10 Despite compelling evidence, many patients with MPE face delays in accessing definitive palliative procedures, undergo multiple nondefinitive procedures, and go through potentially avoidable hospital admissions. [11][12][13][14] Audits of national cancer databases have shown that only 24% of MPE patients receive guideline-consistent care. 12 Although several studies have compared definitive palliative modalities, few have addressed patients' course before these interventions.…”

mentioning

confidence: 99%

Impact of a Pleural Care Program on the Management of Patients With Malignant Pleural Effusions

Alwakeel

Shieh

Gonzalez

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Malignant pleural effusions (MPEs) are common and associated with a poor prognosis. Yet, many patients face suboptimal management characterized by repeated, nondefinitive therapeutic procedures and potentially avoidable hospital admissions. Methods: We conducted a retrospective comparison of patients who underwent a definitive palliative intervention for MPE (indwelling pleural catheter or pleurodesis) at our center, before and after the implementation of a pleural care program. Targeted interventions included staff education, establishment of formal pleural drainage policies, a pleural clinic with weekday walk-in capacity, and a rapid access pathway for oncology patients. Outcomes assessed were the proportion of emergency room (ER) presentations, hospitalizations, number of nondefinitive pleural procedures, and time-to-definitive palliative procedure. Results: A total of 144 patients were included: 69 in the preintervention group and 75 in the postintervention group. Although there was no difference in the proportion of ER presentations before and after interventions (43.5% vs. 38.7%, P=0.56), hospital admissions declined significantly (47.8% vs. 24.0%, P=0.003). The proportion of patients undergoing chest drain insertion decreased significantly (46.4% vs. 13.3%, P<0.001), with a stable low number of nondefinitive procedures per patient (1.6±1.1 vs. 1.3±0.9, P=0.32). A 7-day decrease in median time from presentation-to-definitive palliative procedure (P=0.05) was observed. Conclusion: A targeted pleural care program improved MPE palliation through reduction in hospitalizations and chest drain use, and shorter time-to-definitive palliation, despite failing to reduce ER presentations.

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Early Readmission to Hospital in Patients With Cancer With Malignant Pleural Effusions

Cited by 20 publications

References 37 publications

Association of obesity under different metabolic status with adverse outcomes in patients with chronic myeloid leukemia: A retrospective cohort study

Association of obesity under different metabolic status with adverse outcomes in patients with chronic myeloid leukemia: A retrospective cohort study

Indwelling Pleural Catheters for Malignant Pleural Effusion

Impact of a Pleural Care Program on the Management of Patients With Malignant Pleural Effusions

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