Abstract
Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of readmission for complications. We sought to examine the association between HSCT hospital length of stay and the incidence of readmission and survival after discharge. We retrospectively reviewed the cases of 230 allo-HSCT recipients. The cumulative incidence of readmission with non-relapse transplant-related complications (including infections; acute and chronic GVHD; liver, lung, renal, or neurological complications; and haematological abnormalities) 2 years after the first discharge was 49.7% in patients with length of stay ≤ 100 days (n = 156), and 66.6% in patients with length of stay > 100 days (n = 74) (P = 0.02). The cumulative incidence of readmission with infections 2 years after first discharge was lower in the length of stay ≤ 100 days group than in the length of stay > 100 days patients (27.1 vs. 41.3%, P = 0.04). Length of stay > 100 days was the only risk factor identified that correlated positively with the rate of readmission for non-relapse transplant-related complications [relative risk (RR) 1.53; 95% confidence interval (CI) 1.08–2.18, P = 0.018] or infections [RR 1.64; CI 1.03–2.61; P = 0.038]. Close follow-up of patients with longer length of stay after allo-HSCT is advised.
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References
Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al. One million hematopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol. 2015;2:e91–e100.
Lee SJ, Klein J, Haaqenson M, Baxter-Lowe LA, Confer DL, Eapen M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007;110(13):4576–83.
Sabry W, Le Blanc R, Labbe AC, Sauvageau G, Couban S, Kiss T, et al. Graft-versus-host disease prophylaxis with tacrolimus and mycophenolate mofetil in HLA-matched nonmyeloablative transplant recipients is associated with very low incidence of GVHD and nonrelapse mortality. Biol Blood Marrow Transpl. 2009;15:919–29.
Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med. 2010;363:2091–101.
Erard V, Guthrie KA, Seo S, Smith J, Huang M, Chien J, Flowers ME, et al. Reduced mortality of cytomegalovirus pneumonia after hematopoietic cell transplantation due to antiviral therapy and changes in transplantation practices. Clin Infect Dis. 2015;61(1):31–9.
Bejanyan N, Bolwell BJ, Lazaryan A, Rybicki L, Tench S, Duong H, et al. Risk factors for 30-day hospital readmission following myeloablative allogeneic hematopoietic cell transplantation (allo-HCT). Biol Blood Marrow Transpl. 2012;18(6):874–80.
Rauenzahn S, Truong Q, Cumpston A, Goff L, Leadmon S, Evans K, et al. Predictors and impact of thirty-day readmission on patient outcomes and health care costs after reduced-toxicity conditioning allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2014;20(3):415–20.
Spring L, Li S, Soiffer RJ, Antin JH, Alyea III, Glotzbecker B. Risk factors for readmission after allogeneic hematopoietic stem cell transplantation and impact on overall survival. Biol Blood Marrow Transpl. 2015;21(3):509–16.
Yokota N, Kamimura T, Aoki T, Ito Y, Muraoka H, Tsutsui R, et al. The relationship between distress and prolonged hospitalization after allogeneic hematopoietic stem cell transplantation. J Hematop Cell Transpl. 2013;2:101–8.
Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med. 1999;18(6):695–706.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:456–509.
Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912–9.
Boivin G, Belanger R, Delage R, Beliveau C, Demers C, Goyette N, et al. Quantitative analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay and the COBAS AMPLICOR CMV MONITOR PCR test after blood and marrow allogeneic transplantation. J Clin Microbiol. 2000;38(12):4356–60.
Solano C, Munoz I, Gutierrez A, Farga A, Prosper F, Garcia-Conde J, et al. Qualitative plasma PCR assay (AMPLICOR CMV test) versus pp65 antigenemia assay for monitoring cytomegalovirus viremia and guiding preemptive ganciclovir therapy in allogeneic stem cell transplantation. J Clin Microbiol. 2001;39(11):3938–41.
McKenna DR, Sullivan MR, Hill JM, Lowrey CH, Brown JR, Hickman J, et al. Hospital readmission following transplantation: identifying risk factors and designing preventive measures. J Community Support Oncol. 2015;13(9):316–22.
Ballen KK, Joffe S, Brazauskas R, Wang Z, Aljurf MD, Akpek G, et al. Hospital length of stay in the first 100 days after allogeneic hematopoietic cell transplantation for acute leukemia in remission. Biol Blood Marrow Transpl. 2014;20(11):1819–27.
Wang K, Li P, Chen L, Kato K, Kobayashi M, Yamauchi K. Impact of the Japanese diagnosis procedure combination-based payment system in Japan. J Med Syst. 2010;34(1):95–100.
Yasunaga H, Ide H, Imamura T, Ohe K. Impact of the Japanese diagnosis procedure combination-based payment system on cardiovascular medicine-related costs. Int Heart J. 2005;46(5):855–66.
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The authors would like to thank Mizuho Takeda and Aiko Fujiwara for their assistance with data management.
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AS, YA, KM, and HK designed the study, and wrote the paper; AS and YA analysed the results and made the figures; YO and NK submitted and cleaned the data and reviewed the results.
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Seto, A., Atsuta, Y., Kawashima, N. et al. Impact of hospital length of stay on the risk of readmission and overall survival after allogeneic stem cell transplantation. Int J Hematol 108, 290–297 (2018). https://doi.org/10.1007/s12185-018-2477-4
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DOI: https://doi.org/10.1007/s12185-018-2477-4