Impact of hospital volume on outcomes of autologous stem cell transplant (ASCT) in patients with testicular cancer.

Abstract

e17021 Background: ASCT has a potential to achieve cure in relapsed refractory testicular cancers (TC). A large volume hospital (LVH) is generally recommended but the impact of hospital volume on the outcomes of this therapy is not clearly known. Methods: We included 39435 adult (>18 years) patients with TC from national inpatient sample database from 2016 – 2018. Patients were stratified based on hospital volume. Based on the weighted number of ASCT performed annually, LVH were defined as >45 annual cases, and small volume hospitals (SVH) were defined <25 annual cases. Subgroup analysis was performed for the patients with brain metastasis. Results: A total of 1,225 patients (3.1%) with TC underwent ASCTs between 2016 and 2020. Baseline characteristics are summarized in the table. Patients treated at LVH exhibited a significantly higher median age (p < 0.01), had more proportion with private insurance (p =0.003). Patients treated at SVH experienced significantly higher rates of pneumonia (p < 0.01), vtach (p = 0.02), and neurologic complications (p = 0.02) compared to those at medium volume (MVH) or LVH. Length of stay exceeding 18 days (LOS18) was significantly longer in SVH compared to LVH (p = 0.02). No significant differences in in-hospital mortality were observed based on hospital volume (p = 0.86), even among patients with brain metastases (p = 0.78). LVH had a significantly higher proportion of patients with private insurance compared to MVH and SVH (p = 0.003). Health care costs were significantly higher in SVH and MVH for patients with brain metastases undergoing ASCT compared to LVH (p < 0.01). In adjusted analysis, significant predictors for mortality included liver disease (OR: 6.12, (95% CI: 4.1 to 266); p < 0.01), and electrolyte imbalance (OR: 19, 95% CI (1.6 to 233); p = 0.02). Predictors for LOS18 included AKI (IRR: 1.8, 95% CI (1.17 to 3.05); p = 0.009) and vtach (IRR: 1.04, (1.28 to 8.3); p < 0.01). In LVH, LOS18 was significantly lower (IRR: 0.40, (0.20 to 0.78); p = 0.008). Conclusions: ASCT-related complication rates and length of stay were higher in small volume hospitals that treated testicular cancer which also correlated with higher costs. The study suggests that ASCT should be considered in large volume hospitals. [Table: see text]