Impact of hospital volume on outcomes of patients undergoing chemotherapy for acute myeloid leukemia: a matched cohort study

Giri, Smith; Pathak, Ranjan; Aryal, Madan Raj; Karmacharya, Paras; Bhatt, Vijaya Raj; Martin, Michael

doi:10.1182/blood-2015-01-625764

Cited by 66 publications

(72 citation statements)

References 11 publications

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“…28 For AML, previous studies indicated that mortality rates while undergoing chemotherapy are lower in high-volume vs. low-volume centers despite similar mean LOS and cost. 29 In this study, we found that hospital size was not independently associated with mortality in AML patients requiring ICU care, but that mean LOS and costs were significantly higher at high-volume hospitals. Referral bias of sicker patients to larger hospitals, and increased availability, and therefore use of, resources in larger hospitals may partly explain this observation - a notion supported by data indicating that ICU bed supply increases ICU bed utilization and healthcare spending, even after controlling for severity of illness.…”

Section: Discussionmentioning

confidence: 53%

Association of Risk Factors, Mortality, and Care Costs of Adults With Acute Myeloid Leukemia With Admission to the Intensive Care Unit

et al. 2017

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IMPORTANCE-Adults with acute myeloid leukemia (AML) commonly require intensive care unit (ICU) support, but risk factors for ICU admission and adverse outcomes remain poorly defined.OBJECTIVE-We utilized the University HealthSystem Consortium (UHC) database to examine risk factors, mortality, length of stay (LOS), and cost associated with ICU admission for AML patients. DESIGN-The UHC is a hospitalization database that contains demographic, clinical, and cost variables prospectively abstracted by certified coders from discharge summaries and cost charges generated by UHC institutions from 2004-2012. We extracted information from AML patients were responsible for the conception and design of this article and contributed to the literature search, data analysis and interpretation, and wrote and critically revised the manuscript. G.H.L was responsible for conception and design, acquisition of data, data interpretation, and critically revised the manuscript. E.C contributed to the conception and design, acquisition of data, data analysis and interpretation, statistical analysis, drafting of the manuscript, and critically revised the manuscript. All authors had final approval of the manuscript. A.B.H. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Disclosures: E.C. and G.H.L receive salary support from a research grant from Amgen for their institution. R.B.W. has a consulting/ advisory role for Amphivena Therapeutics, Covagen AG, AstraZeneca, Seattle Genetics and Pfizer and receives research funding from Seattle Genetics, Amgen, Celator, CSL Behring, Seattle Genetics, Amphivena Therapeutics, and Abbvie. PARTICIPANTS-We identified 43,249 patients with AML ≥18 years of age with active AML hospitalized for any cause at UHC hospitals during the timeframe. We excluded patients who had previously undergone hematopoietic cell transplantation. HHS Public AccessMAIN OUTCOME MEASURES-Primary outcomes were ICU admission and inpatient mortality among ICU patients. Secondary outcomes included ICU and total hospitalization LOS and cost.RESULTS-26.1% of identified AML patients required ICU admission. Independent risk factors for ICU admission included age <80 years (odds ratio [OR] =1.56), hospitalization in the South (OR=1.81), hospitalization at a small/medium hospital (OR=1.25), ≥1 comorbidity (OR=10.64 for 5 comorbidities), sepsis (OR=4.61), fungal infection (OR=1.24) and pneumonia (OR=1.73). Inhospital mortality was higher for patients requiring ICU care (43.1% vs. 9.3%), with independent risk factors for death in those patients including age ≥60 (OR=1.16), non-white ethnicity (OR=1.18), hospitalization on the West Coast (OR=1.19), comorbidity burden (OR 18.76 for 5 comorbidities), sepsis (OR=2.94), fungal infection (OR=1.20), and pneumonia (OR=1.13). Mean hospitalization costs were higher for patients requiring ICU care ($83,354 vs. $41,973) and increased with each comorbidity from $50,543 to $124,820 for those with 0 vs. ≥5 ...

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Section: Discussionmentioning

confidence: 53%

Association of Risk Factors, Mortality, and Care Costs of Adults With Acute Myeloid Leukemia With Admission to the Intensive Care Unit

et al. 2017

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“…The type of care center has been linked to survival, with a benefit being shown for patients with acute myeloid leukemia and DLBCL being treated in high volume hospitals. 37,46 More recently, Lamy et al . 47 suggested that even in a universal health care system, disparities in the management of DLBCL patients still exist depending on the type of care center, even after adjustment for differences between patients.…”

Section: Discussionmentioning

confidence: 99%

Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

et al. 2016

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The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients’ care in hematology/oncology departments.

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“…While the association between higher centre volumes and better health outcomes is strongest for surgical procedures, studies have shown a strong relationship between higher centre volumes and lower in-hospital mortality in other complex diseases like patients with HIV/AIDS10 and in patients undergoing chemotherapy 11. The objective of our study was to evaluate the relationship between centre volume, HFH mortality and HFH costs in both Medicare and non-Medicare patients with HF.…”

Section: Introductionmentioning

confidence: 99%

Association of centre volume and in-hospital mortality in heart failure hospitalisations

Madan

Sims

Saeed

et al. 2017

Postgraduate Medical Journal

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Background Centre volume is an important determinant of outcomes in patients requiring complex medical treatments or surgical procedures. Heart failure hospitalisation (HFH) has become an increasingly complex and resource intensive clinical event. We evaluated the effect of centre volume on mortality and costs in patients with HFH. Methods This was a retrospective registry-based analysis of adult patients discharged with a primary diagnosis of HF from hospitals across New York (NY) State over a 5-year period, between January 2009 and December 2013, using the Statewide Planning and Research Cooperative System inpatient discharge files. The primary outcome of interest was in-hospital mortality. All patients were followed from the day of admission to either in-hospital death or discharge alive. Results 300 972 HFHs from 198 facilities across NY State were included. Five-year centre volume was associated with a decrease in in-hospital mortality in unadjusted (HR=0.872, 95% CI 0.863 to 0.881, p<0.001) and adjusted Cox models (HR=0.869, 95% CI 0.859 to 0.879, p<0.001). After dividing the overall cohort into three groups based on 5-year centre volume, groups with medium and high volume centres had lower in-hospital mortality when compared with the group with low volume centres. The results were consistent in various subgroup analyses. Furthermore, hospitals in the higher centre volume groups had increased HFH costs across different severity of illness categories and involved increased use of cardiac procedures. Conclusions Higher centre volume was associated with lower HFH mortality but increased HFH costs and increased cardiac procedures in a cohort of Medicare and non-Medicare beneficiaries.

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Impact of hospital volume on outcomes of patients undergoing chemotherapy for acute myeloid leukemia: a matched cohort study

Cited by 66 publications

References 11 publications

Association of Risk Factors, Mortality, and Care Costs of Adults With Acute Myeloid Leukemia With Admission to the Intensive Care Unit

Association of Risk Factors, Mortality, and Care Costs of Adults With Acute Myeloid Leukemia With Admission to the Intensive Care Unit

Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

Association of centre volume and in-hospital mortality in heart failure hospitalisations

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