Among patients who undergo allogeneic hematopoietic stem cell transplant (allo-HSCT), hospital length of stay is a driver for increased cost and can be predicted using patient- and transplant-related characteristics, as well as posttransplant complications (JCO Oncol Pract. 2020. doi: 10.1200/OP.20.00170).
“Patients who undergo…[allo-HSCT] usually require a prolonged hospital stay that varies greatly across patients. Limited information exists on the factors associated with hospital length of stay after allo-HSCT and the impact on transplant-related costs,” explained Amandeep Godara, MD, Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, and colleagues.
The aim of this study was to determine predictors for longer length of stay for patients undergoing allo-HSCT and assess the impact of these predictors on the cost treatment.
The National Inpatient Sample database was used to identify adult patients hospitalized for all-HSCT using International Classification of Diseases, Ninth Revision, primary and secondary procedure codes.
A total of 68,296 hospitalizations for allo-HSCT were identified between 2002 and 2015. The most common stem-cell sources were peripheral blood (80%), bone marrow (15%), and cord blood (5%).
The median length of stay was 25.8 days. The overall inpatient mortality rate was 8%.
Dr Godara and colleagues found that stem-cell source was a significant predictor for longer hospital length of stay. The length of stay with cord blood was significantly longer (median, 36.9 days; IQR, 26.7-49.9 days) compared with bone marrow (median, 27.2 days; IQR, 21.5-35.2 days) and peripheral blood (median 25.4 days; IQR, 20.8-32.7 days).
Other predictors for extended length of stay were patient characteristics, such as age and race, transplant/post-transplant characteristics, and complications such as total body irradiation use, acute graft-versus-host disease, and infections.
Additionally, longer length of stay was associated with higher hospital costs.
“In patients who undergo allo-HSCT, LOS [length of stay] can be predicted using patient- and transplant-related characteristics as well as post-transplant complications. LOS is also a driver for increased cost, and further efforts are needed to mitigate transplant complications and resource utilization,” Dr Godara and colleagues concluded.—Janelle Bradley
