Incidence and Outcome of Early Hospital Readmission Following Hematopoetic Stem Cell Transplantation in Pediatric and Young Adult Patients

Introduction:Hematopoietic stem cell transplantation (HSCT) provides potential curative treatment for various benign and malignant conditions. However, there is a high rate of patients requiring readmission to the hospital within six months of transplantation. There is only limited literature evaluating risk factors and causes of readmission of children, adolescents and young adults (AYA) who underwent HSCT.

Materials and methods:A retrospective analysis of patients aged ≤ 26 years treated at University of Texas MD Anderson Cancer Center with HSCT was conducted using descriptive measures.

Results: A retrospective chart review of 435 transplants in pediatric and AYA patients from the period of 2008 to 2013 revealed that 161 (37%) patients had at least one hospital readmission within 180 days of transplant. Ninety-five patients were male. The median age at transplant was 21 (range 1-26) years. Primary diagnoses were as follows: hematologic malignancy (n=115), solid tumor (n=32), and non-malignant conditions (n= 17). Lansky or Karnofsky function levels were at a median of 90% at the time of transplant. Amongst patients readmitted, 87% of patients received allogeneic HSCT and 13% had autologous HSCT.  The median number of readmissions per patient was 2 (range 1-6). Twenty-nine (18 %) patients were transplanted more than one time including 4 patient readmits as part of tandem transplant.  Forty-three (29%) patients with solid and hematological malignancies were not in remission at time of transplant. A total of 276 readmission events were reported in the study. The etiology of readmission was multifactorial, and the event etiologies are summarized in Table I. At a median follow up of 23.5 months (range 0.2-72), 88 of 161 readmitted patients remain alive. Causes of death were due to disease recurrence (n=46) and transplant related mortality (n= 27)

Discussion:This is the largest reported pediatric and young adult cohort reporting the etiology of readmission within 6 months after HSCT. The highest cause of readmission was documented infection. Disease relapse contributed to the high mortality of these patients. We aim to define a risk standardized approach to decrease hospital readmissions post HSCT, identify a low risk group of patients and devise intervention(s) that reduce the rate of readmissions.

Table I. Etiology of re-admission
Reason for admission	Events
Documented infection	95 (34%)
GVHD	58 (21%)
Unexplained fever	58 (21%)
Relapse	29 (10%)
Gastrointestinal symptoms	28 (10%)
Other	8 (2%)
Total events	276

Disclosures:

Nothing To Disclose

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