Predictors and Impact of Thirty-Day Readmission on Patient Outcomes and Health Care Costs after Reduced-Toxicity Conditioning Allogeneic Hematopoietic Cell Transplantation

Abstract

Thirty-day readmission (30-DR) has become an important quality-of-care measure. Allogeneic hematopoietic cell transplantation (allo-HCT) presents a medical setting with higher readmission rates. We analyzed factors affecting 30-DR and its impact on patient outcomes and on health care costs in 91 patients who underwent reduced-toxicity conditioning (RTC) allo-HCT with fludarabine and busulfan. The patient cohort was divided into 2: the readmission group (R-gp) or the no-readmission group (NR-gp). Overall, 38% (n = 35) required readmission with a median time to readmission of 14 days. In multivariate analysis, only documented infection during the index admission predicted 30-DR, P =.01. With a median follow-up of 18 months (range, 1 to 69) for surviving patients, the 2-year overall survival was 49% and 58% in the R-gp and NR-gp respectively, P =.48. The 1-year nonrelapse mortality in R-gp and NR-gp was 18% and 13% respectively, P =.43. The median post-transplantation hospital charges in the R-gp and NR-gp were $85,115 (range, $32,015 to $242,519) and $45,083 (range, $10,715 to $485,456), P = .0002. In conclusion, only documented infections during the index hospitalization influenced 30-DR after RTC allo-HCT. Although 30-DR did not adversely affect mortality or survival, it was associated with significantly increased 100-day post-transplantation hospital charges, thus supporting its role as a quality-of-care measure in allo-HCT patients.

Readmissions after Umbilical Cord Blood Transplantation and Impact on Overall Survival

“…Readmissions were also found to be associated with reductions in mortality. Similar studies have demonstrated comparable results [11,12].…”

“…Similar studies assessing readmission rates after myeloablative or reduced-intensity conditioning allogeneic transplantation have also showed high rates of readmission by 30 days from discharge or by day +100 after transplant. In these single-institution studies, infection during the transplant admission was universally found to be a predictor of readmission [10][11][12]. One study also showed that the use of total body irradiation-based conditioning and a higher hematopoietic cell transplantation-specific comorbidity index increased the rate of 30-day readmission rates in patients who had received a myeloablative conditioning allogeneic transplant [11].…”

Risk Factors for Readmission after Allogeneic Hematopoietic Stem Cell Transplantation and Impact on Overall Survival

“…Some centers, including our center, typically discharge RIC patients on day þ1 to 2 after stem cell infusion. A 30-day readmissions study based on 91 patients undergoing transplantation with varying conditioning intensities at West Virginia University between August 2007 and December 2012 demonstrated a 30-day readmission rate of 38% [23]. The only significant risk factor found was documented infection during the index hospitalization.…”

Hospital readmission following transplantation: identifying risk factors and designing preventive measures

“…16,17 Few publications examine readmission rates following hematopoietic stem cell transplantation. 5,[18][19][20][21] A recent study examined readmission rates in 91 allogeneic recipients who received non-myeloablative chemotherapy. 5 Tirty-eight percent of patients were readmitted.…”

“…1 However, readmission rates vary, depending on the underlying diagnosis, patient characteristics, variation in patient care among care givers, and geography. [2][3][4][5][6][7] Te cost of readmissions is astonishing, with Medicare readmissions alone costing the health care system an estimated $28 billion a year. 1 Te Afordable Care Act sanctions Medicare to reduce a hospital's payments if the hospital demonstrates excessive readmission rates.…”