Predictors and Impact Of 30-Day Readmissions On Patient Outcomes and Healthcare Costs After Allogeneic Hematopoietic Cell Transplantation

Readmission within 30 days of hospital discharge has recently become an important topic of discussion and a measure of quality of care. Factors influencing 30-day readmissions and its impact on patient related outcomes are diverse. Allogeneic hematopoietic cell transplantation (allo-HCT) presents a unique medical setting that may be associated with higher readmission rates. We analyzed factors affecting 30-day readmissions, its impact on patient related outcomes and health care costs in allo-HCT patients.

The study group included 91 consecutive patients with hematological malignancies who underwent related (n=44) or unrelated donor (n=47), peripheral blood allo-HCT after conditioning with fludarabine and busulfan +/- thymoglobulin. Subjects were divided into 2 groups; readmission (R-gp), n=35 if they were readmitted within 30 days of hospital discharge after the index hospitalization for a planned allo-HCT, or to no readmission (NR-gp), n=56. The baseline characteristics did not differ between the 2 groups (Table 1). Overall 38% (n=35) required readmission with a median time to readmission of 14 days (range, 1-29). Causes for readmission included documented infections (n=12), cardio-pulmonary complications (n=10), fever (n=6), gastrointestinal disorders (n=4), and graft-versus-host disease (n=3). Median length of stay was 3 days (range, 1-34). In multivariate analysis only documented infection during the index admission predicted 30-day readmission, OR 5.24; 95% CI 1.42-19.32; p=0.01. Caregiver type (spouse vs. others); and number of caregivers (1 vs. >1) did not influence readmission. With a median follow up of 1 year for surviving patients, the estimated overall survival (OS) was 58% and 67% in the R-gp and NR-gp respectively, OR 1.07, 95% CI 0.55-2.06, p=0.85. The 1-yr non-relapse mortality (NRM) in R-gp and NR-gp was 74% and 84% respectively, OR 1.13, 95% CI 0.42-3.03, p=0.80. The median post-transplant hospital charges (inpatient + outpatient) in the R-gp and NR-gp were 85,115.45 USD (mean 93,925.26, range 32,014.86-242,519.35) and 45,083.09 USD (mean 69,142.6, range 10,714.78-485,456.08), p=0.0002.

In conclusion, except for infections during the index admission, no other baseline demographic, social, disease or treatment related factors influenced 30-day readmissions after allo-HCT. 30-day readmission status did not adversely affect OS or NRM, but it significantly increased the 100-day hospital charges. Acknowledging the limitation of our study included its retrospective nature and small sample size, we conclude that 30-day readmission status does not portend poor post transplant outcomes. However, it is associated with higher health care costs.