Abstract 3308: Impact of residency training programs on outcomes of tumor lysis syndrome: A study from national inpatient data
Authors: Desai Aakash , Patel Neel , Sonani Hardik , Parmar Harsh , Reddy Aswanth 
Published: August 2019

Abstract
Background: Limited evidence is available on the effect of residency training on outcomes of
tumor lysis syndrome (TLS)
Objective: Our study measured the difference in outcomes in terms of inpatient length of stay (LOS), cost and mortality in patients with TLS between teaching and non-teaching hospitals.
Design/Methods: We used the National Inpatient Sample (NIS) dataset, a national representative weighted sample of all US hospital discharges, from 2009 to 2014 to identify the diagnosis of TLS (ICD-9 code 277.88) in cancer patients. Data was matched and weighted for purpose of analysis. Hospitals were classified as teaching if they had one or more Accreditation Council for Graduate Medical Education (ACGME) approved residency programs, were a member of the Council of Teaching Hospitals (COTH) or had a ratio of full-time equivalent interns and residents to beds of .25 or higher. Categorical and continuous variables were tested using Chi-square test and Student t-test respectively. Multivariate hierarchical regression was used for the analysis of primary outcomes of interest.
Results: We identified a total of 12,362 cases of TLS from 2009 to 2014. Among them, 6116 (49.47%) were admitted to non-teaching and 6246 (50.52%) to teaching hospitals. Both samples were identical in terms of baseline patient demographics. Patients in both samples were largely comparable in terms of comorbidities (non-teaching vs teaching): Obesity (10.2% vs 9.5%, p=0.166), liver failure (5.7% vs 5.1%,p=0.176), renal failure (20.2% vs 20.8%,p=0.406), coagulopathy (33.7% vs 33%,p=0.387) except for hypertension (46% vs 47.9%, p=0.04) which was more significant in the teaching hospital population.
New onset renal failure requiring dialysis was found in 16.6% of the total population with equal distribution among both the samples (16.9% vs 16.3%, p=0.415). Seizures (1.7% vs 0.9%, p=&lt;0.01) occurred more commonly in the non-teaching population while cardiac dysrhythmias (22.6% vs 27%, p&lt;0.01) were significantly higher in the teaching population.
Even though both the populations were comparable, the mean LOS (≈11.04 days vs ≈14.67, p &lt;0.01) and cost (35,130.86$ vs 40,967.65$, p&lt;0.01) were significantly higher at teaching hospitals with mean difference of 3.63 days and 15,168.47$ respectively. However, the mortality rate was higher in teaching hospitals (22.8% vs 24.7%,p= 0.014), but did not reach statistical significance on regression analysis (OR: 1.096, p=0.345)
Conclusion: There is no overall mortality benefit for TLS patients treated at teaching hospitals despite having a significantly increased length of stay and cost.
With poor overall outcomes for TLS patients and with increasing use of anti-neoplastic agents, early treatment and involvement of specialists is recommended. Further prospective trials are needed to determine an ideal cost effective strategy to address this oncologic emergency.
Citation Format: Aakash Desai, Neel Patel, Hardik Sonani, Harsh Parmar, Aswanth Reddy. Impact of residency training programs on outcomes of tumor lysis syndrome: A study from national inpatient data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3308.