Burden and etiologies of 30-day readmission after bone marrow transplant: Insights from National Readmission Database.

Abstract

e13106 Background: With more centers getting accredited as a bone marrow transplant (BMT) unit, attention has shifted to healthcare care quality metrics such as readmissions. Previous studies have shown high rates of 30-day readmission to be associated with worse long term survival. Except a few single center studies there is no viable data for readmissions for patients undergoing BMT. Methods: This is a retrospective cohort study using the National Readmission Database (NRD) for 2014. All adults with index admission for BMT (autologous and allogenic) were included. Exclusion criteria was age < 18 years, mortality during index admission and inter-hospital transfers. ICD 9 codes were used to identify diagnoses and procedures. Results: A total of 3,972 admissions for BMT were identified. Among these 2,462 underwent autologous (AU) and 1,510 underwent allogenic (AL) transplant, respectively. 30-day readmission rate was 8.6% in AU and 8.2% in AL group. The mean age was 55.9 years and 47.8 years in the AU and AL group, respectively. About 40.5% were females in the AU group and 44.4% in the AL group. Major co-morbidities included Smoking (22.7% in AU and 19.1% in AL), diabetes (13.8% in AU and 12.4% in AL), chronic kidney disease (10% in AU and 4.3% in AL) and prior irradiation (5.7% in AU and 4.5% in AL). Mean length of stay during the index admission was 18 days in AU and 26 days in AL group. Principle diagnosis for undergoing transplant was found as multiple myeloma (59.2% in AU) and AML (25.2% in AL). Major etiologies for readmission were neutropenia (26.9% in AU and 15.8% in AL) followed by Infectious etiologies 26% in AU and 20.4% in AL group, nausea and vomiting 4.3% in AU and 3.2% in AL group. Dehydration accounted for 5.7% in AU group and mucositis 5.7% in AL group. Conclusions: There is a significant readmission rate in this study population. 30-day readmissions in this population are primarily due to neutropenia and infectious etiologies including sepsis and pneumonia. Nausea, vomiting and dehydration played a major role in both categories and remain a major targetable group. We believe there is a dire need for major studies to further evaluate risk factors and predictors for readmission and their impact on overall survival. [Table: see text]