Factors associated with a prolonged hospital stay during induction chemotherapy in newly diagnosed high risk pediatric acute lymphoblastic leukemia

Warrick, Kasper; Althouse, Sandra K.; Rahrig, April; Rupenthal, Joy; Batra, Sandeep

doi:10.1016/j.leukres.2018.06.013

Cited by 7 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Readmission for nontreatment therapy was from 18.5% to 33.3% depending on outcome definitions (e.g., nonelective, unplanned, or unintentional readmission). These results are comparable with previous studies, with 30-day readmission ranging from 23% to 36% [7,23,24]. The top three reasons for readmission were neutropenia/agranulocytosis (27.8%), septicemia (15.3%), and pancytopenia (11.5%).…”

Section: Discussionsupporting

confidence: 89%

“…This finding is supported by a study by Wedekind et al [7], who showed a longer length of stay is associated with decreased risk of readmission (OR 0.44, 95%CI 0.35-0.56) vs. a short length of stay during induction therapy in newly diagnosed ALL children. In contrast, Warrick et al [23] recommended aggressive discharge plans during induction chemotherapy for newly diagnosed high/very high risk ALL pediatric patients because of no difference in the likelihood of readmission. This discrepancy between Wedekind et al (using a U.S. national representative sample) and Warrick et al (using an institutional sample) could be due to the difference in the quality of care among hospitals or coding practice among hospitals.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy among Acute Lymphoblastic Leukemia Patients

et al. 2020

View full text Add to dashboard Cite

Chemotherapy for acute lymphoblastic leukemia (ALL) patients is complex and intense, resulting in a high readmission rate. We aimed to identify the incidence, causes, and risk factors of readmission following inpatient chemotherapy among ALL patients, using 2016 National Readmission Database. We applied three different definitions of 30-day readmission: (1) nonelective readmission based on readmission type, (2) unplanned readmission defined by CMS, and (3) unintentional readmission, combining (1) and (2). We used unweighted multivariable Poisson regression with robust variance estimates for risk factors analysis, including patient-, hospital-, and admission-related characteristics. Percentage for nonelective, unplanned, and unintentional readmission were 33.3%, 22.4%, and 18.5%, respectively. The top three causes for unplanned readmissions were neutropenia/agranulocytosis (27.8%), septicemia (15.3%), and pancytopenia (11.5%). Risk ratios for unintentional readmission were 1.21 (1.08–1.36) for nonelective vs. elective admission, 1.19 (1.06–1.33) for public vs. private insurance enrollees, 0.96 (0.95–0.98) for each day of hospital stay, 0.77 (0.62–0.95) for large teaching and 0.87 (0.70–1.08) for small teaching vs. nonteaching hospitals. Possible strategies to reduce readmission among ALL patients could be shortening the gap in quality of care among teaching vs. non-teaching hospitals, understanding the difference between privately vs. publicly insured patients, and avoiding aggressive discharge after chemotherapy.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy among Acute Lymphoblastic Leukemia Patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…8,21 Prolonged hospital stay could be due to organ dysfunction, infectious or metabolic complications. 22 The duration of induction was significantly longer in the malnourished compared to the wellnourished group. Another study also found that the majority of ALL children who did not complete chemotherapy on time were severely malnourished.…”

Section: Discussionmentioning

confidence: 89%

Differences in induction phase outcomes of acute lymphoblastic leukemia between well-nourished and malnourished pediatric patients

Simarmata¹,

Rosdiana

Wahyuni

2023

View full text Add to dashboard Cite

Background Leukemia is the most common malignancy in childhood. Malnutrition is the main nutritional disorder occurring in children with cancer. Nutritional supportive care is a medical modality that has been associated with improved tolerance to chemotherapy, survival, and quality of life, as well as decreased risk of infection in children undergoing cancer therapy. Objective To examine differences in induction phase outcomes in well-nourished and malnourished pediatric acute lymphoblastic leukemia (ALL) patients. Methods This prospective study was conducted in newly-diagnosed ALL patients aged 1 to 18 years who underwent induction phase chemotherapy at Haji Adam Malik General Hospital, Medan, North Sumatera. Mid-upper arm circumference (MUAC) was used to determine nutritional status. Patient characteristics such as complete blood count (CBC) at the time of diagnosis, occurrence of febrile neutropenia, duration of induction, length of hospital stay, and remission status were collected. We analyzed differences in CBC, frequency of febrile neutropenia, as well as duration of induction and hospital stay between well-nourished and malnourished patients. We also assessed the difference in remission attainment between the two groups. Results There were 21 subjects in each group. Compared to well-nourished subjects, malnourished ones had a higher median incidence of febrile neutropenia [1 (range 0 to 30) vs. 3 (range 0 to 4); P=0.04], longer mean induction duration [64.2 (SD 11.5) vs. 71.2 (SD 10.6) days; P=0.046], and longer median hospital stay [30 (range 19 to 56) vs. 36 (range 22 to 49) days; P=0.001] compared to well-nourished subjects. There was no significant difference in CBC parameters and remission status after induction between the two groups. Conclusion Malnourished pediatric ALL patients had a significantly higher incidence of febrile neutropenia, duration of induction phase, and duration of hospital stay compared to well-nourished ALL patients.

show abstract

“…The pooled prevalence of VRE colonization among patients with hematological malignancies was 24% (95% CI, 16%–34%) [ 29 ], which is similar to the values detected in this study. The increased risk in the hematology-oncology wards might also be associated with an ongoing exposure to healthcare environments due to prolonged hospital stay and readmission and with more frequent antimicrobial treatment due to febrile neutropenia [ 32 ]. Clinical practice guidelines recommend cefepime (4th cephalosporin generation) as the initial antibiotic monotherapy, while fluoroquinolones prophylaxis is recommended for all high-risk hematological patients [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Vancomycin-Resistant Enterococcus spp. Intestinal Carriage among High-Risk Patients in University Hospitals in Serbia

et al. 2022

View full text Add to dashboard Cite

The predictors of intestinal carriage of vancomycin-resistant Enterococcus spp. (VRE) among high-risk patients in the counties of the Southeast Europe Region are insufficiently investigated, yet they could be of key importance in infection control. The aim of the study was to identify risk factors associated with fecal VRE colonization among high-risk inpatients in university hospitals in Serbia. The study comprised 268 inpatients from three university hospitals. Data on patient demographics and clinical characteristics, length of hospital stay, therapy, and procedures were obtained from medical records. Chi-squared tests and univariate and multivariate logistic regressions were performed. Compared to the hemodialysis departments, stay in the geriatric departments, ICUs, and haemato-oncology departments increased the risk for VRE colonization 7.6, 5.4, and 5.5 times, respectively. Compared to inpatients who were hospitalized 48 h before stool sampling for VRE isolation, inpatients hospitalized 3–7, 8–15, and longer than 16 days before sampling had 5.0-, 4.7-, and 6.6-fold higher risk for VRE colonization, respectively. The use of cephalosporins and fluoroquinolones increased the risk for VRE colonization by 2.2 and 1.9 times, respectively. The age ≥ 65 years increased the risk for VRE colonization 2.3 times. In comparison to the University Clinical Centre of Serbia, the hospital stays at Zemun and Zvezdara University Medical Centres were identified as a protector factors. The obtained results could be valuable in predicting the fecal VRE colonization status at patient admission and consequent implementation of infection control measures targeting at-risk inpatients where VRE screening is not routinely performed.

show abstract

Factors associated with a prolonged hospital stay during induction chemotherapy in newly diagnosed high risk pediatric acute lymphoblastic leukemia

Abstract: A significant proportion of newly diagnosed HR or VHR pediatric ALL patients experience a prolonged LOS and unplanned re-admissions. Aggressive discharge planning and close follow up is indicated in this cohort of patients.

Cited by 7 publications

References 26 publications

Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy among Acute Lymphoblastic Leukemia Patients

Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy among Acute Lymphoblastic Leukemia Patients

Differences in induction phase outcomes of acute lymphoblastic leukemia between well-nourished and malnourished pediatric patients

Predictors of Vancomycin-Resistant Enterococcus spp. Intestinal Carriage among High-Risk Patients in University Hospitals in Serbia

Contact Info

Product

Resources

About