Abstract LB-A17: Hospital volume determines mortality amongst neutropenic cancer patients within the United States

Abstract

Abstract Introduction: Hospital Volume is associated with improved outcomes in cancer surgery, and some aspects of cancer care. The influence of hospital volume on outcomes in neutropenic patients is unknown. Neutropenia secondary to bone-marrow suppression is a common, and dangerous complication of cancer treatment. Known factors associated with increased mortality include age, race and co-morbidities. We hypothesized that large-volume hospitals would have reduced mortality rates for neutropenic patients compared with small-volume institutions. Methods: We utilized the NIS database of the Healthcare Cost and Utilization Project, focusing on the years 2000-2006. Only inpatient episodes with a diagnosis of both neutropenia and cancer were included in the study. Hospital volume was defined as the number of neutropenic cancer episodes listed for each institution per year. Mortality was defined as death during admission. Results: 155,512 hospitalizations were included in the study, from 3049 different institutions. Median age was 60 years. The overall inpatient mortality was 7.1%. Mortality increased with patient age, for instance amongst those aged 30-39 years it was 4.3% compared to 10.7% for those aged 70-79 years. The average number of “neutropenic” inpatient episodes in each institution per year ranged from less than one to 225 (median 22.7). The population was split into four equal groups based upon hospital volume. Mortality was 8.5%, 7.7%, 7.0% and 5.2% for each group (from lowest to highest volume), likewise% discharged home was 77.3%, 82.4%, 85.2% and 90.1% (for both p<0.001). In a logistic regression model incorporating age, race and sex, ‘hospital volume’ remained statistically associated with reduced mortality (p<0.001). Conclusion: Neutropenic patients hospitalized in large-volume institutions have a substantially lower mortality and a higher likelihood of returning home compared to those hospitalized at low-volume institutions. Our findings have implications for the setting in which phase I/II clinical trials of combination treatments with new biological agents and cytotoxic therapies be performed. Citation Format: Yaacov Richard Lawrence, Damian Urban, Tal Sella, Jair Bar, Raanan Berger, Jeffrey Goldstein, Einat Shacham-Shmueli, Zvi Symon, Talia Golan. Hospital volume determines mortality amongst neutropenic cancer patients within the United States. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr LB-A17.