High Resource Utilization and Predictable Complications Drive Readmissions in Chronic Lymphocytic Leukemia: A 2022 Nationwide Readmissions Database Analysis
Introduction/Background/Significance: CLL is one of the most common types of leukemia. With new advances, we’ve seen an increase in survival for patients, yet there's still a lot we can learn to further improve care. Through this analysis, we try to identify key comorbidities, as well as hospital- and payer-specific factors, that play an important role in increased readmissions in CLL 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 chronic lymphocytic 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 44,581.91 index admissions; of these, 10,463.97 were readmitted within 90 days of their initial hospitalization. During the index stay, 3,113.489 died. The average length of stay for index admissions was 6.91 days, with mean total charges of $92,231.20 and mean costs of $23,356.88. For those readmitted, the average stay was 7.32 days, with mean charges of $93,451.04 and mean costs of $23,251.92. Altogether, the readmission group accounted for 76,582.24 hospital days, $971 million in charges, and $242 million in costs. In multivariable analysis, several factors were significantly associated with 90-day readmission among patients with chronic lymphocytic leukemia. Higher Charlson comorbidity index (≥3) increased risk of readmission (aHR 1.12, p=0.008). Longer length of stay during the index admission was also linked to higher readmission risk (aHR 1.005, p< 0.001). Insurance status played a role: patients with other government insurance had a higher risk of readmission compared to those with private insurance (aHR 1.50, p=0.010), while those with Medicaid had a lower risk (aHR 0.84, p=0.001). Several comorbid conditions were independently associated with increased readmission risk, including heart failure (aHR 1.23, p< 0.001), acute kidney injury (aHR 1.15, p< 0.001), chronic kidney disease (aHR 1.08, p=0.026), atrial fibrillation (aHR 1.12, p=0.001), and tumor lysis syndrome (aHR 1.45, p< 0.001). Among non-cancer-related causes of 90-day readmission in CLL, infections were the most common drivers. Sepsis-related diagnoses, including unspecified, Gram-negative, E. coli, and Pseudomonas sepsis, accounted for approximately 828 readmissions, followed closely by COVID-19 (980 cases) and pneumonia of various types (534 cases). Cardiovascular and renal complications were also frequent, with hypertensive heart and chronic kidney disease (with or without heart failure) contributing to nearly 784 cases, and acute kidney injury accounting for 285. Other notable causes included urinary tract infections (174), aspiration pneumonitis (163), atrial fibrillation (118), respiratory failure (220), neutropenia (80), NSTEMI (80), pleural effusion (95), COPD exacerbation (80), cellulitis of the lower limb (64), and infections related to urinary catheters (101).
Conclusions: Many CLL readmissions were from preventable complications like infections and kidney issues. Identifying high-risk patients based on comorbidities and hospital factors can guide targeted follow-up, reduce readmissions, and improve resource utilization and ultimately improve patient care.
References
Chronic Lymphocytic Leukemia https://www.ncbi.nlm.nih.gov/books/NBK470433/
