Mortality among oncology patients with multiple unplanned hospital admissions.
Authors: Roberts Thomas J , McGuire Jessica , Temel Jennifer S. , Lage Daniel E , Greer Joseph A. , Mulvey Therese Marie 
Published: June 2023

6578

Background: Previous work has shown that patients with solid tumors with an unplanned hospital admission have a median overall survival of approximately six months, and readmission rates are high within this patient population, especially near the end of life. However, the relationship between multiple unplanned hospital admissions and survival and whether patient characteristics are associated with differences in survival have not been studied in this patient population. Methods: We recorded all hospital admissions to an inpatient oncology unit for patients with solid tumors from October 1, 2021, through September 30, 2022 and categorized admissions as planned (chemotherapy administration or desensitization) or unplanned. For all unplanned admissions we reviewed the electronic health record for unplanned admissions in the previous six months. For patients with one or more prior unplanned admission, we captured demographics, admitting diagnosis, discharge disposition, and vital status including date of death. We examined median overall survival for patients with two unplanned hospital admissions within six months, median survival for patients with three or more unplanned hospital admissions within six months and 90-day survival in patients with two or more unplanned admission. We also used multivariate Cox proportional hazards models to evaluate whether patient demographics, cancer type, and hospital length of stay were associated with differences in survival. Results: There were 1,561 unplanned admissions during the period of analysis. Of these admissions, 692 (44%) were preceded by at least one unplanned admission within the prior six months. A total of 400 patients had two or more admissions. Forty-five percent of readmitted patients had a diagnosis of gastrointestinal malignancy. Median overall survival for patients after a second unplanned admission was 76 days (95% CI 60 - 110), and median overall survival after a third unplanned admission was 50 days (95% CI 35 - 99). Median overall survival was 49 days (95% CI 39 - 67) for readmitted patients with a length of stay of at least seven days. Ninety-day survival was 45% (95% CI 39 – 51) among patients with two admissions and 34% (95% CI 26 – 43) among patients with three or more admissions. In multivariable models, longer length of stay was associated with decreased survival (HR 1.03, 95% CI 1.01-1.05). Age and sex were not associated with differences in survival, and overall survival was similar across all disease groups except head and neck, which was associated with improved survival (HR 0.42, 95% CI 0.21-0.85). Conclusions: Patients with solid tumors with multiple unplanned hospital admissions in less than six months represent a distinct population with exceptionally poor outcomes, regardless of the primary tumor site and patient demographics. This easily identifiable population may benefit from targeted interventions to improve the quality of end-of-life care.