title: Risk factors for 30-day hospital readmission following myeloablative allogeneic hematopoietic cell transplantation (allo-HCT).
abstract: Patient readmission within 30 days from discharge has been perceived by the Centers for Medicare and Medical Services as an indicator of poor healthcare quality for specific high-cost medical conditions. Patients who undergo allogeneic hematopoietic cell transplantation (allo-HCT) are often being readmitted. Our study identified the risk factors for 30-day readmission among 618 adult recipients of myeloablative allo-HCT from 1990 to 2009. Two hundred forty-two (39%) of 618 patients (median age = 42 years [range: 18-66]) were readmitted a median of 10 days (range: 1-30) from their hospital discharge. Median duration of readmission was 8 days (range: 0-103). Infections (n = 68), fever with or without identified source of infection (n = 63), gastrointestinal complications (n = 44), graft-versus-host disease (GVHD) (n = 38), and other reasons (n = 29) accounted for 28%, 26%, 18%, 16%, and 12% of readmissions, respectively. During their index admission, patients who were subsequently readmitted had more documented infections (P < .001), higher hematopoietic cell transplantation comorbidity index (HCT-CI) (P < .01), total body irridiation (TBI)-based conditioning (P < .001), unrelated donor (P < .001), and peripheral stem cell (P = .014) transplantation. In multivariable analysis, HCT-CI (odds ratio [OR] = 1.78; 95% confidence interval [CI], 1.25-2.52), TBI-based preparative regimen (OR = 2.63; 95% CI, 1.67-4.13), and infection during admission for allo-HSCT (OR = 2.00; 95% CI, 1.37-2.92) predicted 30-day readmission. Thirty-day readmission itself was an independent predictor of all-cause mortality (hazard ratio [HR](Adj) = 1.66; 95% CI, 1.36-2.10). Our data emphasize the importance of a risk-standardized approach to 30-day hospital readmission if it is used as a quality-of-care metric for bone marrow transplantation.
authors: Taussig Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. bejanyn@ccf.org
authors: Nelli
authors: N
authors: Bejanyan
authors: Brian J
authors: BJ
authors: Bolwell
authors: Aleksandr
authors: A
authors: Lazaryan
authors: Lisa
authors: L
authors: Rybicki
authors: Shawnda
authors: S
authors: Tench
authors: Hien
authors: H
authors: Duong
authors: Steven
authors: S
authors: Andresen
authors: Ronald
authors: R
authors: Sobecks
authors: Robert
authors: R
authors: Dean
authors: Brad
authors: B
authors: Pohlman
authors: Matt
authors: M
authors: Kalaycio
authors: Edward A
authors: EA
authors: Copelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D007945:Leukemia, Lymphoid / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D007951:Leukemia, Myeloid / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation