Readmission Rates After Autologous Hematopoietic Stem Cell Transplantation

With increasing scrutiny of healthcare expenditures, policy proposals have highlighted the reduction in hospital readmission rates as a method by which to improve the cost and the quality of medical care. To date, readmission rates following bone marrow transplantation procedures have been sparsely described. A retrospective review of consecutive patients who underwent autologous hematopoietic stem cell transplantation (AHSCT) at a single institution over a five-year period was performed to determine the number and causes of readmission within one year post-transplantation. Each readmission was classified according to the primary presenting symptom or an identified etiology following inpatient clinical evaluation. 485 patients received high-dose chemotherapy followed by an AHSCT from 1/2004 to 12/2008 for varied disease indications including non-Hodgkin lymphoma (n=252, 52%), multiple myeloma and/or amyloidosis (124, 26%), Hodgkin lymphoma (83, 17%), and other malignant diseases (26, 5%). Of these, 142 (29%) required at least one inpatient readmission within one year, accounting for 216 discrete events. 45 patients (9%) were readmitted more than once. 60 of all readmissions (28%) occurred within the first 30 days of transplantation, and 131 (61%) within the first 100 days. 45% of all readmissions were due to infection or unexplained fever, 17% to gastrointestinal causes, 13% to relapsed disease or new secondary malignancy, 8% to cardiopulmonary symptoms, and 6% to neurological symptoms, with the remainder of admissions related to thromboembolic disease, refractory pain symptoms, hepatic dysfunction, or other causes. Among those patients admitted within 30 days, 63% presented with infection or fever and 23% with gastrointestinal symptoms. The majority of those readmitted with gastrointestinal toxicity (9/14) were patients with non-Hodgkin lymphoma. Further study of this high-risk patient group and of the reasons for readmission may identify outpatient supportive care measures that could be enacted to decrease both AHSCT-related morbidity and associated healthcare costs.