Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission: A nationwide analysis

Philip Kanemo; Keffi Mubarak Musa; Vaishali Deenadayalan; Rafaella Litvin; Olubunmi Emmanuel Odeyemi; Abdultawab Shaka; Naveen Baskaran; Hafeez Shaka

doi:10.5306/wjco.v14.i8.311

Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission: A nationwide analysis

World J Clin Oncol. 2023 Aug 24;14(8):311-323. doi: 10.5306/wjco.v14.i8.311.

Authors

Philip Kanemo¹, Keffi Mubarak Musa², Vaishali Deenadayalan³, Rafaella Litvin³, Olubunmi Emmanuel Odeyemi⁴, Abdultawab Shaka⁵, Naveen Baskaran⁶, Hafeez Shaka³

Affiliations

¹ Department of Internal Medicine, Rapides Regional Medical Center, Alexandria, LA 71301, United States.
² Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria 88445, Kaduna, Nigeria. keffimubarakmusa@gmail.com.
³ Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60623, United States.
⁴ Department of Internal Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso 210101, Oyo, Nigeria.
⁵ Department of Medicine, Windsor University School of Medicine, St. Kitts, Frankfort, IL 60423, United States.
⁶ Department of Medicine, University of Florida, Gainesville, FL 32610, United States.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment.

Aim: To determine the effect of COVID-19 pandemic on cancer patients' care.

Methods: A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata^® Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study.

Results: A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, P < 0.05], paralysis (HR = 1.26, P < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, P = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, P < 0.01), paralysis (HR = 1.21, P = 0.02), and peripheral vascular disorders (HR = 1.15, P < 0.01).

Conclusion: The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Keywords: Cancer; Chemotherapy; Coronavirus disease 2019 pandemic; Healthcare cost; Nationwide readmission database; Readmission rates.