Medical Complications and Prognostic Factors for Medically Unstable Conditions During Acute Inpatient Cancer Rehabilitation

Abstract

PURPOSE: Acute inpatient rehabilitation provides concurrent medical care and intensive rehabilitation. We sought to describe the nature of types of medical complications and to identify the more frequent types of medical complications management in patients with cancer undergoing acute inpatient rehabilitation. METHODS: We reviewed the records of all consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017, through February 28, 2018. Presenting problem noted to be a significant change in medical status using the Centers for Medicare & Medicaid Services' Evaluation and Management Service Guide was defined as a medical complication. We recorded demographic and clinical characteristics. Multivariable logistic regression analysis was performed to assess prognostic factors for returning to acute care. RESULTS: Among 165 evaluable patients, 158 (96%) had at least one medical complication, and 31 (19%) had an unplanned return to acute care. After excluding three patients who had planned return to acute care, there was a cohort of 162 patients and the most common medical complication categories were electrolyte abnormalities 81 (50%), musculoskeletal 70 (43%), genitourinary or renal 61 (38%), hematologic 58 (36%), and cardiovascular problems 46 (28%). Multivariable analysis showed that tachycardia (odds ratio [OR], 7.83; 95% CI, 2.23 to 27.54; P = .001) and weekly or more frequent RBC transfusions (OR, 5.23; 95% CI, 1.39 to 19.64; P = .014) were independently associated with unplanned return to acute care. CONCLUSION: A high frequency and wide range of medical complications and interventions occur in patients with cancer undergoing acute inpatient rehabilitation. Close monitoring and expertise are needed for this patient population.

Thirty‐day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation

“…21 Infection is also a common reason for returning to acute-care oncology services from acute inpatient cancer rehabilitation. 16 The median time to readmission was 14 days in this study, which is close to the median of 10 to 13 days reported in the literature for patients with cancer. 25,28,33 The three risk factors that were found to be significantly and independently associated with readmission were decreased locomotion scores at discharge, increased the total number of medications at discharge, and decreased hemoglobin at discharge.…”

“…16 Interestingly, we have also previously noted the same rate (21%) of planned and unplanned transfer back to acute-care oncology services. 16 Furthermore, inadequate continuities of care after hospital discharge have often been noted in patients with cancer, who thus require closer coordination of care. 34 In our cohort, the most common reason for readmission was infection, which has been reported to be one of the more common reasons for readmission in cancer patients 7 as well as in other patients discharged from acute inpatient rehabilitation.…”

Analysis of Adherence to Acute Inpatient Rehabilitation in Patients with Cancer

“…When patients are transferred from acute medical care to acute inpatient rehabilitation, their medical condition should be stable [1] and they should be able to tolerate 3 hours of rehabilitation daily to prevent readmission to acute medical care services [6]. Although some studies [4,[7][8][9] have evaluated risk factors for return to acute care services and our previous study have evaluated medically unstable conditions [4] during acute inpatient rehabilitation in patients with cancer, further studies are needed to delineate the various and extensive unstable medical conditions as well as other reasons that prevent full participation during acute inpatient rehabilitation. Besides treatment time, the content of rehabilitation activities and patients' tolerance to those activities are important factors to be considered when evaluating overall functional gain.…”

“…We did not assess adherence based on the total number of rehabilitation sessions since patients had an additional rehabilitation session on a weekday (6 th ) day beyond the requirement of 3 hours of rehabilitation sessions per day at least 5 days out of the week. In identifying reasons for incomplete rehabilitation sessions, problems identified as moderate or high risk of complications in the medical decision-making section of CMS guidelines [5] were defined as medical complications [4]. The details regarding these complications were described previously [4].…”

“…In identifying reasons for incomplete rehabilitation sessions, problems identified as moderate or high risk of complications in the medical decision-making section of CMS guidelines [5] were defined as medical complications [4]. The details regarding these complications were described previously [4]. Data were managed using Research Electronic Data Capture for descriptive statistical analysis.…”