Abstract
PurposeThis study sought to evaluate factors associated with hospital length of stay in cancer patients with febrile neutropenia.MethodsA prospective cohort study was performed at a single tertiary referral hospital in southern Brazil from October 2009 to August 2011. All adult cancer patients with febrile neutropenia admitted to the hematology ward were evaluated. Stepwise random-effects negative binomial regression was performed to identify risk factors for prolonged length of hospital stay.ResultsIn total, 307 cases of febrile neutropenia were evaluated. The overall median length of hospital stay was 16 days (interquartile range 18 days). According to multiple negative binomial regression analysis, hematologic neoplasms (P = 0.003), high-dose chemotherapy regimens (P<0.001), duration of neutropenia (P<0.001), and bloodstream infection involving Gram-negative multi-drug-resistant bacteria (P = 0.003) were positively associated with prolonged hospital length of stay in patients with febrile neutropenia. The condition index showed no evidence of multi-collinearity effect among the independent variables.ConclusionsHematologic neoplasms, high-dose chemotherapy regimens, prolonged periods of neutropenia, and bloodstream infection with Gram-negative multi-drug-resistant bacteria are predictors of prolonged length hospital of stay among adult cancer patients with febrile neutropenia.
Highlights
IntroductionThe absolute neutropenia caused by intensive cytotoxic chemotherapy increases the risk of severe infections, which frequently require hospitalization for administration of broadspectrum antibiotics to minimize morbidity and mortality [1,2]
Febrile neutropenia (FN) is a common complication of cancer treatment
Given that diagnostic and treatment procedures in patients with FN are often associated with large financial expenditures, prolonged length of stay (LOS) has a negative impact on healthcare resource use and costs [6,7]
Summary
The absolute neutropenia caused by intensive cytotoxic chemotherapy increases the risk of severe infections, which frequently require hospitalization for administration of broadspectrum antibiotics to minimize morbidity and mortality [1,2]. Hospital length of stay (LOS) is an important marker of clinical severity and use of resources in the context of FN [3]. Neutropenic cancer patients who require prolonged LOS are at increased risk of multi-drug-resistant (MDR) infections and delays in their antineoplastic treatments [4,5], which can, in turn, have implications for cancer treatment outcomes. Given that diagnostic and treatment procedures in patients with FN are often associated with large financial expenditures, prolonged LOS has a negative impact on healthcare resource use and costs [6,7]. The median cost of hospitalization per episode of FN may be as high as $24,000 USD [3] with an attributable cost excess greater than $12,000 USD [8]
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