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

Abstract

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.

Determinants of Quality of Life in Family Caregivers of Patients With Leukemia: A Cross-Sectional Study

“…The findings of our study demonstrated that physical functioning was significantly affected by the number of admissions in the last month. As leukemia treatment is considered complex and intensive, it often results in frequent readmissions (Tran et al, 2020). This can not only have physical limitations on the patient but also create a financial burden on the caregivers, who may have to take time off from work to care for the patient.…”

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

“…Percentage of unplanned readmission in a study by Tran et al were (22.4%). The top three causes for unplanned readmissions were neutropenia/ agranulocytosis (27.8%), septicemia (15.3%), and pancytopenia (11.5%) [8]. 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.…”