Impact of hospital length of stay on the risk of readmission and overall survival after allogeneic stem cell transplantation
- 117 Downloads
Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of readmission for complications. We sought to examine the association between HSCT hospital length of stay and the incidence of readmission and survival after discharge. We retrospectively reviewed the cases of 230 allo-HSCT recipients. The cumulative incidence of readmission with non-relapse transplant-related complications (including infections; acute and chronic GVHD; liver, lung, renal, or neurological complications; and haematological abnormalities) 2 years after the first discharge was 49.7% in patients with length of stay ≤ 100 days (n = 156), and 66.6% in patients with length of stay > 100 days (n = 74) (P = 0.02). The cumulative incidence of readmission with infections 2 years after first discharge was lower in the length of stay ≤ 100 days group than in the length of stay > 100 days patients (27.1 vs. 41.3%, P = 0.04). Length of stay > 100 days was the only risk factor identified that correlated positively with the rate of readmission for non-relapse transplant-related complications [relative risk (RR) 1.53; 95% confidence interval (CI) 1.08–2.18, P = 0.018] or infections [RR 1.64; CI 1.03–2.61; P = 0.038]. Close follow-up of patients with longer length of stay after allo-HSCT is advised.
KeywordsAllogeneic stem cell transplantation Risk factors Length of stay Readmission
The authors would like to thank Mizuho Takeda and Aiko Fujiwara for their assistance with data management.
AS, YA, KM, and HK designed the study, and wrote the paper; AS and YA analysed the results and made the figures; YO and NK submitted and cleaned the data and reviewed the results.
Compliance wih ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. A summary of relevant information will be published with the manuscript.
- 3.Sabry W, Le Blanc R, Labbe AC, Sauvageau G, Couban S, Kiss T, et al. Graft-versus-host disease prophylaxis with tacrolimus and mycophenolate mofetil in HLA-matched nonmyeloablative transplant recipients is associated with very low incidence of GVHD and nonrelapse mortality. Biol Blood Marrow Transpl. 2009;15:919–29.CrossRefGoogle Scholar
- 5.Erard V, Guthrie KA, Seo S, Smith J, Huang M, Chien J, Flowers ME, et al. Reduced mortality of cytomegalovirus pneumonia after hematopoietic cell transplantation due to antiviral therapy and changes in transplantation practices. Clin Infect Dis. 2015;61(1):31–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Rauenzahn S, Truong Q, Cumpston A, Goff L, Leadmon S, Evans K, et al. Predictors and impact of thirty-day readmission on patient outcomes and health care costs after reduced-toxicity conditioning allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2014;20(3):415–20.CrossRefGoogle Scholar
- 13.Boivin G, Belanger R, Delage R, Beliveau C, Demers C, Goyette N, et al. Quantitative analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay and the COBAS AMPLICOR CMV MONITOR PCR test after blood and marrow allogeneic transplantation. J Clin Microbiol. 2000;38(12):4356–60.PubMedPubMedCentralGoogle Scholar
- 14.Solano C, Munoz I, Gutierrez A, Farga A, Prosper F, Garcia-Conde J, et al. Qualitative plasma PCR assay (AMPLICOR CMV test) versus pp65 antigenemia assay for monitoring cytomegalovirus viremia and guiding preemptive ganciclovir therapy in allogeneic stem cell transplantation. J Clin Microbiol. 2001;39(11):3938–41.CrossRefPubMedPubMedCentralGoogle Scholar