Frequency and Reasons for Return to the Primary Acute Care Service Among Patients With Lymphoma Undergoing Inpatient Rehabilitation

Abstract

Objective To assess the frequency and risk factors for return to the primary acute care service among lymphoma patients undergoing inpatient rehabilitation. Design Retrospective study. Setting Tertiary referral-based cancer center. Patients All patients with a history of lymphoma admitted to inpatient rehabilitation between October 1, 2003 and January 30, 2013. Main Outcome Measures Items analyzed from patient records included return to the primary acute care service with demographic information, lymphoma characteristics, medications, hospital admission characteristics, and laboratory values. Results 143 unique patient admissions were analyzed. 54/143 (38%) of lymphoma inpatient rehabilitation admissions returned to the primary acute care service. However, 16/54 (30%) returned due to needing additional chemotherapy. Excluding patients who returned to the primary acute care service for chemotherapy, statistically significant or approaching statistically significant factors (p<.10) associated with return to the primary acute care service included a creatinine greater than or equal to 1.3 milligrams/deciliter (mg/dL) (p=0.0002), male sex (p=0.001), history of hematopoietic stem cell transplant (p=0.0355), and presence of intravenous antifungal agent (p=0.0717). Of those transferred back to the primary acute care service; 13/38 (34%) discharged directly home, 10/38 (26%) died in the hospital, 7/38 (18%) transferred to a subacute rehabilitation facility, and 4/38 (11%) transferred to inpatient rehabilitation. Conclusions Chemotherapy was the most common reason for return to the primary acute care service. When excluding patients who returned for chemotherapy, lymphoma patients who are male, who have had a hematopoietic stem cell transplant, and have a creatinine greater than or equal to 1.3 mg/dL demonstrated increased risk for return to the primary acute care service.

Characterization of Cancer Patients in Inpatient Rehabilitation Facilities: A Retrospective Cohort Study

“…Reported readmission rates among cancer patients in inpatient rehabilitation in the United States have ranged from 17% to 35%. 8,42–44 We found that among all cancer patients in our cohort, 16% were discharged to acute care. In addition, we also found that patients with blood and lymphatic cancers were most likely to be discharged back to the acute care setting (28%); other studies 8,44,45 have also reported leukemia and lymphoma patients as having a higher likelihood of discharge from inpatient rehabilitation to acute care settings (33% and 38%, respectively).…”

“…8,42–44 We found that among all cancer patients in our cohort, 16% were discharged to acute care. In addition, we also found that patients with blood and lymphatic cancers were most likely to be discharged back to the acute care setting (28%); other studies 8,44,45 have also reported leukemia and lymphoma patients as having a higher likelihood of discharge from inpatient rehabilitation to acute care settings (33% and 38%, respectively). However, we do not have data as to how many of these cancer patients would have been readmitted to acute care if they had not received the inpatient rehabilitation, nor do we know how many of these readmissions were planned for additional cancer treatment.…”

Does rehabilitation pose a risk to patients suffering from haemato‐oncological diseases? Results of a monocentric, retrospective analysis in Germany

“…As it is difficult to assess the severity of any complications that have occurred, we have chosen the procedure that is often used in this context: we took premature discontinuation of the rehabilitation as a criterion for serious complications during the rehabilitation stay (Alam, Wilson, & Vargo, ; Asher et al, ; Fu et al, , ; Fu, Lee, Smith, & Bruera, ; Fu, Lee, Smith, Guo, et al, ; Guo, Persyn, Palmer, & Bruera, ). In order to be able to assess whether rehabilitation stays of patients with haemato‐oncological diseases have to be discontinued particularly frequently in our rehabilitation facility, we compared the frequency of termination of rehabilitation stay in patients with solid tumours with those who suffer from a haemato‐oncological disease.…”

“…We investigated to what extent the risk factors investigated so far like age, body mass index (BMI), serum albumin deficiency, gender, renal function, leucocytes, thrombocytes, haemoglobin value, CRP, antimycotic, antibiotic or antiviral agents and the level of remission at the beginning of rehabilitation (Asher et al, ; Fu et al, ; Fu, Lee, Smith, & Bruera, ; Fu, Lee, Smith, Guo, et al, ; ; Guo et al, ) are true for our patients. We analysed the data of all patients with haemato‐oncological diseases and separately of those after high‐dose chemotherapy with allogeneic stem cell transplantation.…”

“…It is quite common to carry out rehabilitation on these patients, but they often have to be transferred to an acute clinic. In addition, risk factors for an unplanned termination of rehabilitation could be identified (Fu et al, ; Fu, Lee, Smith, & Bruera, ; Fu, Lee, Smith, Guo, & Bruera, ; Fu et al, ; Mix et al, ), but there is insufficient information on the extent to which the high rate of termination of rehabilitation stays can be seen as a consequence of illness and therapy or as being caused by the rehabilitation stay. Therefore, we have not only determined the rate of unplanned termination of rehabilitation stays and tried to identify risk factors in our rehabilitation facility, but also tried to understand to what extent the conditions during a rehabilitation stay are causally related to the termination of rehabilitation.…”