Patients With ALL Have High Readmission Risk Post Chemotherapy, but Hospitals Can Change That

Patients with acute lymphoblastic leukemia (ALL) who undergo chemotherapy face a significant risk of readmission within 30 days, with the most common cause being neutropenia/agranulocytosis, according to a new study.

Investigators from the University of Florida, including corresponding author Joshua Brown, PharmD, PhD, MS, wanted to gain a better understanding of the implications of the decisions hospitals make following the “complex and intense” treatment of chemotherapy for patients with ALL. They pulled data from the 2016 National Readmissions Database, which includes information from 27 states and encompasses 57% of all hospitalizations in the United States.

The authors chose to look at 30-day readmissions as a proxy for quality of acute care and because curbing readmission rates has become an important goal for CMS as it aims to lower health care costs.

For their analysis, which was published in the journal Healthcare, Brown and colleagues used 3 definitions of 30-day readmission:

• Nonelective readmission, based on readmission type
• Unplanned readmission, based on a definition by CMS
• “Unintentional readmission,” which is a combination of the first and second definitions.

Overall, nonelective readmissions were the most common (33.3%), followed by unplanned readmission (22.4%) and unintentional readmission (18.5%).

The authors said they believe the third definition is the most appropriate one for thinking about the readmission problem, since it was the strictest definition. In general, their readmission findings are similar to other studies, they added, although the combined definition did result in a slightly lower percentage than most other studies, which they said range from 23% to 36%.

One factor that seemed to affect readmission rates was the length of time a patient spent in the hospital during their initial stay—despite a longer stay only reducing the risk of readmission in patients in remission or reinduction who had not achieved remission. Longer hospital stays did not lower readmission risk in newly relapsed patients, they wrote.

In terms of the most common causes of readmission, 3 causes rose to the top:

1. Neutropenia/agranulocytosis: 27.8%
2. Septicemia: 15.3%
3. Pancytopenia: 11.5%

Brown and colleagues noted that the risk of each of these complications can be reduced with prophylactics and other prevention strategies, as well as strong infection control protocols. They said other tactics can help address the problem, too. For instance, shortening the time to treatment during an emergency visit would help reduce readmissions, as would understanding differences in private and public insurance.

The authors noted that patients on public insurance had higher rates of readmission compared with patients who were privately insured. They also said large teaching hospitals tended to do better in terms of avoiding readmissions.

“This may be a result of better quality of care in large teaching hospitals or better care of the emergency department in teaching hospitals, which were able to provide the medical care needed and discharge patients without requiring readmitting patients,” they said.

They concluded that hospitals should discourage aggressive discharging of patients with ALL who undergo chemotherapy.

Reference:

Tran PT, Slayton WB, Dalal M, Brown J. Incidence and risk factors for 30-day readmission after Published October 14, 2020. doi:10.3390/healthcare8040401