Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D2-190; Seattle, WA 98109-1024, USA.
Haematologica. 2011 Jun;96(6):914-7. doi: 10.3324/haematol.2011.040220. Epub 2011 Mar 10.
Due to infectious and bleeding risks, adults with acute myeloid leukemia or high-risk myelodysplastic syndromes typically remain hospitalized after remission induction chemotherapy until blood count recovery. Here, we explored the medical and financial effects of discharge immediately after chemotherapy completion with close outpatient follow up. Within 12 months, 15 patients fulfilling both medical and logistical criteria were discharged early, whereas 5 patients meeting medical criteria only served as inpatient controls. No patient died. Patients discharged early spent a median of 8 days (range 3-36 days), or 54% of their study time, as outpatients. These patients required less time on intravenous antibiotics (6 vs. 16 days; P=0.11), received fewer red blood cell transfusions (0.25 vs. 0.48 units/day; P=0.08), and incurred lower median daily charges ($3,270 vs. $5,467; P=0.01) than controls. Thus, early discharge of selected patients appears, safe and may reduce cost and resource utilization. (ClinicalTrials.gov Identifier: NCT00844441).
由于感染和出血的风险，成人急性髓系白血病或高危骨髓增生异常综合征患者通常在缓解诱导化疗后仍需住院，直到血象恢复。在此，我们探讨了在化疗完成后立即出院并密切进行门诊随访的医疗和经济效果。在 12 个月内，满足医疗和后勤标准的 15 名患者提前出院，而仅符合医疗标准的 5 名患者作为住院对照。没有患者死亡。提前出院的患者中有中位数 8 天（范围 3-36 天），或研究期间的 54%时间，作为门诊患者。这些患者需要静脉用抗生素的时间更少（6 天与 16 天；P=0.11），需要输注红细胞的次数更少（0.25 单位/天与 0.48 单位/天；P=0.08），且每日平均费用更低（3270 美元与 5467 美元；P=0.01）。因此，选择的患者提前出院是安全的，可能会降低成本和资源利用。（临床试验标识符：NCT00844441）。
