title: 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.
authors.affiliation: Department of Internal Medicine, West Virginia University, Morgantown, West Virginia.
authors.forename: Sherri
authors.initials: S
authors.lastname: Rauenzahn
authors.affiliation: Section of Hematology/Oncology, West Virginia University, Morgantown, West Virginia.
authors.forename: Quoc
authors.initials: Q
authors.lastname: Truong
authors.affiliation: Department of Pharmacy, West Virginia University, Morgantown, West Virginia; Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cumpston
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
authors.forename: Londia
authors.initials: L
authors.lastname: Goff
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Leadmon
authors.affiliation: Department of Pharmacy, West Virginia University, Morgantown, West Virginia.
authors.forename: Kim
authors.initials: K
authors.lastname: Evans
authors.affiliation: Department of Biostatistics, West Virginia University, Morgantown, West Virginia.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics, West Virginia University, Morgantown, West Virginia.
authors.forename: Sijin
authors.initials: S
authors.lastname: Wen
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Craig
authors.affiliation: Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia. Electronic address: abesebastian@yahoo.com.
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Kanate
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002066:Busulfan / Q000627:therapeutic use; D003428:Cross Infection / Q000191:economics / Q000209:etiology / Q000276:immunology / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000191:economics / Q000276:immunology / Q000401:mortality / Q000473:pathology; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000191:economics* / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D010359:Patient Readmission / Q000191:economics*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000191:economics* / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
keywords: Allogeneic hematopoietic cell transplantation; Health care cost; Reduced-toxicity conditioning; Thirty-day readmission