Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy Among Acute Lymphoblastic Leukemia Patients

Background: chemotherapy for acute lymphoblastic leukemia (ALL) patients is complex and intense, resulting in their high readmission rate. Modifiable risk factors may exist to reduce their readmission.

Objectives: To identify the incidence, causes, and risk factors of readmission following inpatient chemotherapy among ALL patients.

Design: A retrospective cohort using the 2016 National Readmission Database.

Subjects: ALL children and adults receiving inpatient chemotherapy.

Measurements: We applied three different definitions of 30-day readmission: (1) nonelective readmission based on readmission type reported by hospitals, (2) unplanned readmission defined by the algorithm developed by the Center for Medicare and Medicaid Services, and (3) unintentional readmission, combining of (1) and (2). We used a weighted survey procedure to calculate incidence and unweighted, multivariable Poisson regression with robust variance estimates for risk factors analysis, including patient-, hospital- and admission-related characteristics.

Results: Percentage for nonelective, unplanned, and unintentional readmission were 33.3%, 22.4%, and 18.5%, respectively. Top three causes for unplanned readmissions were neutropenia/agranulocytosis (27.8%), septicemia (15.3%) and pancytopenia (11.5%). Risk ratios for unintentional readmission were 1.21 (1.08-1.36) for nonelective vs elective admission, 1.19 (1.06-1.33) for public vs private insurance enrollees, 0.96 (0.95-0.98) for each day of hospital stay, 0.77 (0.62-0.95) for large, teaching, and 0.87 (0.70-1.08) for small teaching vs non-teaching hospitals.

Conclusions: Possible strategies to reduce readmission among ALL patients could be shortening the gap in quality of care among teaching vs non-teaching hospitals, understanding the difference of privately vs publicly insured patients, and avoiding aggressive discharge after chemotherapy.