Factors Associated With Unplanned 30-Day Readmissions After Hematopoietic Cell Transplantation Among US Hospitals

Abstract

IMPORTANCE Hematopoietic cell transplantation (HCT) is a therapeutic strategy in the management of several hematological cancers. Limited data exist on the incidence and predictors of 30-day readmission after HCT. OBJECTIVE To measure the incidence of and risk factors associated with 30-day readmission following HCT in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined patient data from the US population-based Nationwide Readmissions Database. All adults (age Ն18 years) who underwent autologous (auto-) or allogenic (allo-) HCT in US hospitals between January 1, 2012, and November 30, 2014, were included. The analysis was performed from June 2018 to February 2019. MAIN OUTCOMES AND MEASURES The main outcome was 30-day readmission rates for auto-HCT and allo-HCT. Factors associated with readmission, including baseline demographic characteristics and disease-and hospital-related characteristics (including annual case volume), were measured. RESULTS A total of 28 356 index admissions for auto-HCT in 244 centers (191 low-volume, 38 medium-volume, and 15 high-volume centers) and 17 217 index admissions for allo-HCT in 211 centers (161 low-volume, 37 medium-volume, and 13 high-volume centers) were identified during the study period. The overall 30-day readmission rates were 11.6% for auto-HCT and 24.4% for allo-HCT. The odds of readmission were significantly higher in low-volume hospitals compared with high-volume hospitals (adjusted odds ratio [aOR], 1.69; 95% CI, 1.08-2.64 for auto-HCT and aOR, 1.41; 95% CI, 1.09-1.82 for allo-HCT) but comparable to medium-volume hospitals (aOR, 1.06; 95% CI, 0.62-1.83 for auto-HCT and aOR, 1.19; 95% CI, 0.90-1.57 for allo-HCT). Other factors associated with readmission for auto-HCT included younger age (aOR for age Ն50 vs <49 years, 0.82; 95% CI, 0.68-0.98), female sex (aOR, 1.21; 95% CI, 1.06-1.36), disease type (aOR for other vs myeloma, 1.37; 95% CI, 1.06-1.77), and Elixhauser comorbidity index score (aOR for Ն20 vs 0, 1.5; 95% CI, 1.17-1.93). For allo-HCT, factors associated with readmission included disease type (aOR for acute lymphoblastic leukemia vs acute myelogenous leukemia, 1.30; 95% CI, 1.04-1.62), insurance (aOR for Medicare vs private, 1.18; 95% CI, 1.02-1.36), and Elixhauser comorbidity index score (aOR for 1-9 vs 0, 1.2; 95% CI, 1.04-1.39). Infections, neutropenic fever, and gastrointestinal symptoms were the most common reasons for readmission for both types of HCT. CONCLUSIONS AND RELEVANCE This study found substantial rates of readmission for both types of HCT and an inverse association between hospital HCT volume and 30-day readmission. These results may provide guidance when developing quality indicators and policies penalizing hospitals for HCT readmission.

Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices

“…The Elixhauser Comorbidity Index (ECI) is an inventory of comorbidities [21], later updated to predict mortality [22, 23] and readmission [24]. Both the Charlson and Elixhauser indices have been associated with readmission outcomes in surgical conditions [25–27], psychiatric conditions [28], and hospitalizations due to other medical conditions and procedures [29–31].…”

Unplanned 30-Day Readmissions after Hyper-CVAD Chemotherapy in Patients with Acute Lymphoblastic Leukemia

“…unplanned readmission after autologous and allogenic hematopoietic cell transplants were 11.6% and 24.4%, respectively in a study by Dhakal et al Although similar studies have not been found in patients with acute leukemia after chemotherapy, this is lower than the study by Dhakal et al on unplanned readmission after autologous and allogenic hematopoietic cell transplants that were 11.6% and 24.4%, respectively. The most common reasons for re-hospitalization included infection, gastrointestinal complains and hospital stem cell transplantation volume that was inversely associated with readmission rate [9]. If Compared the readmission rate to the study by H. Hoyer (20%) and Spring et al (21%) , it is surprisingly lower [10,11].…”

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

“…The 30-day readmission is a popular well-accepted measurement for the quality of acute care. Readmission beyond this period is less likely due to the quality of inpatient care and rather due to patients' behavior, disease progression, or medical care after discharge [7][8][9]. To reduce healthcare costs while providing high-quality services for patients, the Center for Medicare and Medicaid Services (CMS) uses the payment penalty for unplanned readmission and proposes penalties for unplanned hospitalization after chemotherapy.…”

“…Literature regarding readmission typically uses the CMS definition of unplanned readmission, which is not applied for children with cancer. All readmissions are considered unplanned except admission for disease progression and continuation of therapy [7][8][9]. Most researchers use the CMS algorithm to define readmission.…”