Unplanned 30-Day Readmission and Predictors of Readmission in Patients with Neutropenic Fever : Insights from National Readmission Database
Authors: Kaur Supreet , Saha Aparna , Siddiqui Mohamed Tausif , Poojary Priti , Ratnani Parita , Kollimuttathuillam Sudarsan , Kumar Abhishek , Maroules Michael 
Published: October 2019

BACKGROUND: Early readmissions are important indicators of quality of care. No data exist describing hospital readmissions in Neutropenic fever. The aim of this study was to describe unplanned, 30-day readmissions among adult neutropenic fever patients and to assess readmission predictors.

METHODS: We analyzed the 2013 and 2014 United States National Readmission Database and identified neutropenic fever admissions using ICD-9 CM administrative codes in patients older than 18 years of age. Our primary outcome was a 30-day, unplanned readmission rate. We used chi-square tests, t tests, and Wilcoxon rank-sum tests for descriptive analyses and survey logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations with readmissions adjusting for confounders.

RESULTS: In the cohort of 52,017 hospitalizations with neutropenic fever, 7, 440 (14.3%) had at least one unplanned 30-day readmission. 50% of the readmissions occurred within the first two weeks of the index admission. The most common reasons for unplanned 30-day readmission were due to disease of the white blood cells (32.5%), anemia and other deficiency (5.8%), complications related to implants, grafts or procedure during index admission (3.9%), recurrent fever (3.6%) and septicemia (3.2%). Neutropenic fever patients with readmissions were more likely to be older, males and have blood malignancy like acute leukemia along with comorbidities including chronic renal disease, hypertension, diabetes and chronic liver disease. Those with readmissions were sicker on index admissions with extreme likelihood of dying on the APR-DRG mortality scale, have non-elective admissions, CCI score of 3 and longer length of stay. Interestingly, index admissions with readmissions were more likely to have primary payer of Medicare and Medicaid insurance and less likely to have a routine discharge home. Admissions with readmissions had higher mean (±SE) cost on index admissions, $10,564 (±199) vs $12,057 (±388), P<0.0001. The mean cost of readmission was an additional $14,117 (±462). Multivariable analysis showed amongst blood malignancies, only acute leukemia (both myeloid and lymphoid) is associated with higher odds for readmission (aOR 1.2, 95% CI 1.1 - 1.4, p=0 .01) whereas malignancies with lower odds of readmissions included breast cancer, colorectal, lung cancer, and prostate cancer. Also, younger population (aged 18-60 years and 61-70 years) were less likely to be associated with readmission (aOR* 0.86, 95% CI 0.8 - 0.99, p=0 .04 and aOR 0.89, 95% CI 0.79- 0.99, p = 0.04 respectively) as compared to age >70 years. We also observed that the comorbidities with the higher aOR for readmissions were Diabetes Mellitus (aOR 1.2, 95% CI 1.04 - 1.4, p=0 P=0.01), Chronic liver disease (aOR 1.29, 95% CI 1.01 - 1.7, p=0 .05) as well as patient who received blood transfusion (aOR 1.22, 95% CI 1.1 - 1.4, p=0 .0001). Index admission characteristics associated with increased odds of readmission included elective admissions and higher APRDRG mortality scale scores. Within insurance categories, Medicaid insurance were more likely to have readmissions as compared to self-pay. With respect to hospital characteristics, patients getting discharged to home health care, larger bed size hospitals, teaching hospitals and metropolitan hospitals had significantly higher odds of readmission.

CONCLUSIONS: On a national level, 1 in 7 hospitalizations for febrile neutropenia was followed by an unplanned readmission within 30 days with readmissions equally distributed over the 30 days. Multiple modifiable and non-modifiable factors influencing readmission rates were noted which should be targeted for further studies to examine if strategies that address these predictors can decrease readmissions.

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Disclosures

No relevant conflicts of interest to declare.