Elucidating the connection between pneumonia and melanoma: Risk factors and outcomes for patients with melanoma.

Abstract

e21561 Background: Pneumonia is a common cause of morbidity and mortality in patients with melanoma and leads to many ED visits per year in the US. However, there is no national-level study that has assessed factors that increase risk for melanoma patients to present to the ED with a primary diagnosis of pneumonia. Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to identify melanoma patients that presented to the emergency department (ED) with a primary diagnosis of pneumonia. A multivariate logistic regression was used to identify characteristics that were significantly associated with a higher chance of pneumonia. A p-value less than 0.05 was considered significant. Results: Between 2006 and 2012, 239,956 melanoma patients presented to the ED. Amongst these patients, 3.1% presented to the ED with a primary diagnosis of pneumonia. The majority of patients were at least 80 years old (64.3%), male (61.5%), Medicare beneficiaries (73.1%), of the highest income quartile (28.7%), living in the South (35.7%), presented to non-trauma hospitals (53.1%), and presented to metropolitan non-teaching hospitals (44.9%). Factors associated with the highest risk of pneumonia in melanoma patients are the following: Medicaid patients (odds ratio (OR): 2.5, 95% Confidence Interval (CI): 1.4-4.4, p=0.003), Medicare patients (OR: 2.3, 95% CI: 1.4-3.0, p=0.002), private insurance patients (OR: 2.1, 95% CI: 1.3-3.5, p=0.005), non-metropolitan teaching hospitals (OR: 1.6, 95% CI: 1.3-1.9, p<0.001), living in the Northeast (OR: 1.3, 95% CI: 1.3-3.5, p=0.005), being male (OR: 1.3, 95% CI: 1.1-1.4,p<0.001) a high Charlson Comorbidity Index (OR: 1.3, 95% CI: 1.2-1.3, p<0.001). The majority of patients were either admitted (86.4%) or discharged home the same day (11.1%). Amongst the patients that were admitted, most patients were discharged (59.0%), transferred to a skilled nursing facility or intermediate care facility (19.2%), or given home health care (15.8%). Only 4.0% of admitted patients died in the hospital. Conclusions: A melanoma patient’s risk for developing pneumonia is depending on insurance status, the region of their hospital, their biological sex, and the presence of comorbidities. Clinicians should be aware of these risk factors to minimize the risk of pneumonia occurring in this at-risk population.