title: Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit.
abstract: BACKGROUND
  Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population.
  
  
  OBJECTIVE
  To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center.
  
  
  METHODS
  All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015.
  
  
  METHODS
  Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics.
  
  
  RESULTS
  One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P < .001).
  
  
  CONCLUSIONS
  Because of their medical fragility, clinicians caring for rehabilitation inpatients with multiple myeloma should maintain close contact with the primary oncology service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia.
  
  
  METHODS
  IV.
authors.affiliation: Department of Palliative, Rehabilitation and Integrative Medicine, Unit 1414, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030(∗). Electronic address: jfu@mdanderson.org.
authors.forename: Jack B
authors.initials: JB
authors.lastname: Fu
authors.affiliation: Department of Exercise and Sports Sciences, New Mexico Highlands University, Las Vegas, NM(†).
authors.forename: Jay
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡).
authors.forename: Ben C
authors.initials: BC
authors.lastname: Shin
authors.affiliation: Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA(§).
authors.forename: Julie K
authors.initials: JK
authors.lastname: Silver
authors.affiliation: Department of Educational Psychology, University of Houston, Houston, TX(¶).
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Smith
authors.affiliation: Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX(#).
authors.forename: Jatin J
authors.initials: JJ
authors.lastname: Shah
authors.affiliation: Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(∗∗).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation* / Q000628:therapy; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011379:Prognosis; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome