Factors influencing early readmission among breast, lung, and colorectal cancer patients admitted for febrile neutropenia: A Nationwide Readmissions Database (NRD) analysis.

Abstract

e13105 Background: Febrile neutropenia accounts for some of the highest mortality among oncology patients. Several patient and treatment related factors contribute to these outcomes. However, there remains a gap in the literature regarding readmissions among patients after recovery from febrile neutropenia admissions in the setting of cancer and its treatment. Through this analysis, we aim to identify statistically significant factors associated with higher healthcare utilization and frequent readmissions in this population. Methods: We conducted a retrospective analysis of the 2022 Nationwide Readmissions Database (NRD), part of the Healthcare Cost and Utilization Project (HCUP). Hospitalizations for febrile neutropenia among patients with diagnosed breast, lung, and colorectal cancer were identified and categorized as index admissions, those discharged alive were followed for 90 day readmissions. Survey weighted logistic, linear, and Cox proportional hazards regression models were used to compare clinical and hospital-level characteristics and to identify predictors of 90 day readmission. Results: A total of 5,336.169 weighted patients met eligibility criteria and were categorized as index admissions. Among these, 1,341.106 patients experienced at least one readmission within 90 days. There were 311.33 deaths during index admissions. Resource utilization for index admissions versus 90-day readmissions was as follows: mean length of stay 6.37 vs 6.79 days, mean total charges 66,507.09 vs 74,039.91 USD, and mean total costs 17,845.69 vs 19,526.61. Cumulative LOS was 34,007.78 vs 9,113.21 days, with cumulative charges 353.0M vs 99.1M and cumulative costs 94.7M vs 26.1M. Patients with a higher comorbidity burden (Charlson category 3 vs 1) had increased hazards of readmission (adjusted hazard ratio [aHR] 1.44, p = 0.001). In addition, longer index length of stay showed statistically significant increase in readmission hazard per additional hospital day (aHR 1.01, p = 0.020). Conclusions: Approximately 25% of patients were readmitted within 90 days, and readmissions were associated with higher resource utilization and substantial system-level burden. Higher comorbidity burden and longer index length of stay independently predicted readmission. Infectious etiologies and treatment-related toxicities were leading causes, highlighting key targets to improve care and reduce healthcare burden Leading principal causes of 90-day readmissions (Weighted Patient Counts). Principal Diagnosis Weighted Patient Count Sepsis 306.68 Neutropenia / agranulocytosis 203.81 Pneumonia 79.96 Secondary malignant neoplasms 38.54 Encounter for antineoplastic chemotherapy 38.50 Acute kidney failure 37.37 Respiratory Failure 32.38 Neoplasm-related pain 26.83 C. difficile enterocolitis 20.16