PS1271 PREDICTORS, RATES AND COSTS ASSOCIATED WITH READMISSION FOR CLOSTRIDIUM DIFFICILE INFECTION WITHIN 90 DAYS OF HEMATOPOIETIC STEM CELL TRANSPLANTATION: INSIGHT FROM THE NATIONWIDE READMISSION DATABASE

Abstract

Background:Clostridium difficile infection (CDI) is a common and serious disease attributable to substantial morbidity, and mortality following the bone marrow transplant in pediatric population. Rates of readmission, during the first 3‐month follow‐up are poorly characterized.Aims:We aimed to identify rates, predictors and hospitalization cost of CDI readmission after Hematopoietic Stem Cell Transplant (HSCT) using the Nationwide Readmission Database (HCUP‐NRD)Methods:Using administrative claim codes for CDI in the 2014 Nationwide Readmission Database, pediatric patients admitted after HSCT with at least 3 months of follow‐up were included for analysis. Patients were stratified according to HSCT type, either Umbilical Cord Blood Transplant (UCBT) or Bone Marrow Transplant (BMT) which was further stratified into autologous and allogenic transplantation, then evaluated for CDI readmission through day 90.Results:A total of 2057 pediatric patients met the inclusion criteria, including 2.2 % that received UCBT, 97.8% that received BMT. All‐causes readmission rate was 65% (1338/2057) and CDI readmission rate was 4.7% (63/1338). The mean age was 4 years, 71.4% were male, mean length of stay was 12.9 days and the median time lapsed after transplant discharge and CDI readmission was 52 days. Medicaid was the most common payer at 54.7%. The median cost per CDI admission was $67999 with net total cost $12.2 million. The respective rates of CDI 90‐day readmission according to transplant type were 11.5% for UCBT and 88.5% for BMT (p < 0.001). The most frequent diagnosis associated with CDI readmission in the first 90 days was neuroblastoma (19.5%; p < .001)Summary/Conclusion:Conclusion(s): (1) Among pediatric patients treated with HSCT, CDI 90‐day readmission rate is significant and associated with significant high cost. (2) The most common diagnosis associated with high burden of CDI 90day readmission was neuroblastoma. (3) Additional study is warranted to evaluate factors that may lead to decreased rate of CDI readmissions following HSCT