McKenna Dorothy R, Sullivan Matthew R, Hill John M, Lowrey Christopher H, Brown Jeremiah R, Hickman Joshua, Meehan Kenneth R
Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire, USA.
Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
J Community Support Oncol. 2015 Sep;13(9):316-22. doi: 10.12788/jcso.0168.
About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.
To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.
We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.
36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (𝑃 = .55 for allogeneic patients; 𝑃 = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.
Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.
In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.
所有住院患者中约七分之一在出院后30天内再次入院。再入院成本高昂，仅医疗保险再入院每年就让医疗系统花费约280亿美元。
确定接受造血干细胞移植的患者在100天内的再入院率及原因。
我们对235例连续的移植受者（自体移植，n = 144；异体移植，n = 91）进行了回顾性研究，以确定移植患者在100天内的再入院率及原因。对每位患者的病历和医院再入院情况进行了审查。
36例异体移植患者出现56次再入院。23例自体移植患者出现26次再入院。自体移植受者最常见的再入院原因是发热（n = 15例患者）或心肺问题（n = 4例）。异体移植受者再入院的最常见原因包括发热（n = 21例）或移植物抗宿主病的发生或加重（n = 5例）。异体移植患者的再入院住院时间为6天（中位范围，1 - 91天），自体移植患者为4天（中位范围，1 - 22天）。再入院组和未再入院组之间的生存率无差异（异体移植患者P = 0.55；自体移植患者P = 0.24）。尽管异体移植受者的再入院率（39.6%）高于自体移植受者（16%），但所检查的变量，包括年龄、性别、体能状态、诊断、移植时的缓解状态、合并症、预处理化疗方案类型或供体类型，均未识别出再入院风险增加的患者。
在检查再入院率时，需要考虑临床护理、医生做法和患者特征的差异。大多数异体移植患者群体包括接受非清髓性预处理方案的无关供体受者（65%）（占所有异体移植受者的81%）。这些特征可能并非其他中心所特有。
在这些高危患者中，移植后再入院很常见。护士和药剂师加强出院前教育，以及通过电话或社交媒体进行持续门诊教育和严格的门诊随访，可能会降低再入院率。
