title: Hospital readmission following transplantation: identifying risk factors and designing preventive measures.
abstract: BACKGROUND
  About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.
  
  
  OBJECTIVE
  To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.
  
  
  METHODS
  We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.
  
  
  RESULTS
  36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (𝑃 = .55 for allogeneic patients; 𝑃 = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.
  
  
  CONCLUSIONS
  Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.
  
  
  CONCLUSIONS
  In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.
authors: Dorothy R
authors: DR
authors: McKenna
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.
authors: Matthew R
authors: MR
authors: Sullivan
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.|Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
authors: John M
authors: JM
authors: Hill
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.|Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
authors: Christopher H
authors: CH
authors: Lowrey
authors: The Dartmouth Institute for Health Policy and Clinical Practice and Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
authors: Jeremiah R
authors: JR
authors: Brown
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.
authors: Joshua
authors: J
authors: Hickman
authors: Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA. Kenneth.R.Meehan@hitchcock.org.|Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
authors: Kenneth R
authors: KR
authors: Meehan
keywords: complications; health care costs; hematopoietic stem cell transplant; readmission