Common Causes and Healthcare Utilization Associated With 90-Day All-Cause Readmissions Following Index Hospitalization for Acute Myeloid Leukemia: An Analysis of the National Readmissions Database
Introduction/Background/Significance: Acute myeloid leukemia accounts for nearly one-third of all leukemia cases and causes over 11,000 deaths annually. Gaps remain in understanding how hospital- and patient-level factors influence early readmissions. This study aims to identify significant predictors of 90-day readmission to help reduce preventable mortality and improve outcomes for patients
Materials and Methods/Case Presentation/Objective: We conducted a retrospective study using the 2022 Nationwide Readmissions Database (NRD), part of the Healthcare Cost and Utilization Project. Patients hospitalized with a diagnosis of acute myeloid leukemia between January and October were selected as the study population. The first readmission within 90 days of the initial (index) hospitalization was used to define the readmission cohort. Using survey-weighted logistic, linear, and Cox regression models, we examined clinical and hospital-level characteristics and identified predictors of 90-day readmission
Results/Description/Main Outcome Measures: We identified 23,182 index admissions; of these, 9,965 were readmitted within 90 days of their initial hospitalization. During the index stay, 2,353 died. The average length of stay for index admissions was 15.6 days, with mean total charges of $236,529 and mean costs of $61,678. For those readmitted, the average stay was 17.5 days, with mean charges of $256,280 and mean costs of $66,604. Altogether, the readmission group accounted for 174,314 hospital days, $2.51 billion in charges, and $652 million in costs. Patients treated at medium-sized (aHR 1.23) or large (aHR 1.28) hospitals, and those discharged from urban teaching facilities (aHR 1.18), had a higher likelihood of returning to the hospital. Patients discharged from government non-federal hospitals had a lower risk of readmission compared to those at private hospitals (aHR 0.80). Insurance status played a role: patients with Medicaid (aHR 1.13) or no insurance (self-pay; aHR 1.45) were more likely to be readmitted compared to those with Medicare. Readmission risk was significantly higher in patients with gout (aHR 1.37), HIV (aHR 2.99), neutropenia (aHR 1.16), and tumor lysis syndrome (aHR 1.27). Among non-cancer-related causes of 90-day readmission, the most common were sepsis (approximately 1,800 weighted cases), pancytopenia (979), neutropenia (943), COVID-19 (245), and pneumonia (222), followed by stem cell transplant complications, transfusion reactions, and acute kidney injury
Conclusions: Many AML readmissions were related to sepsis, neutropenia, and pancytopenia, highlighting opportunities for early follow-up or prophylaxis. Patients without stable insurance or those discharged from large hospitals faced a higher risk of early readmission, suggesting that system-level gaps in continuity of care persist. Addressing these issues could help reduce preventable readmissions and improve outcomes
References
American Cancer Society https://www.cancer.org/cancer/types/acute-myeloid-leukemia/about/key-statistics.html?utm_source=chatgpt.com Journal of Clinical Oncology https://ascopubs.org/doi/10.1200/JCO.2025.43.16_suppl.12064
