Potentially Avoidable Hospitalizations in Older Patients with Acute Myeloid Leukemia (AML)

• Published in: Blood 2015-12, Vol.126 (23), p.3310-3310
• Main Authors: El-Jawahri, Areej, Keenan, Tanya, Abel, Gregory, Steensma, David P., LeBlanc, Thomas W., Traeger, Lara, Fathi, Amir T., DeAngelo, Daniel J., Wadleigh, Martha, Hobbs, Gabriela, Amrein, Philip C., Stone, Richard M., Ballen, Karen K., Chen, Yi-Bin, Temel, Jennifer S.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V126.23.3310.3310

Background: Many older adults (≥60) with AML have a poor prognosis and spend a high portion of their life from diagnosis until death in the hospital. Using a large cohort, we examined the reasons for hospitalizations and identified those which are potentially avoidable. Methods: We conducted a retrospective analysis of 329 consecutive patients (≥60) diagnosed with AML between 5/1/2005 and 12/31/2011 at two major tertiary care hospitals to examine the reasons for hospitalizations during treatment. Practicing physicians used a consensus-driven medical record review process to identify primary reason for each hospitalization and categorize it as "potentially avoidable" or "not avoidable" based on a novel adaptation of the Graham's criteria for potentially avoidable hospital admissions. We compared the rate of potentially avoidable hospitalizations between older patients receiving intensive chemotherapy (n=197) versus non-intensive chemotherapy (n=132) using multivariate logistic regression analysis controlling for age, gender, marital status, disease risk, comorbidities, and the receipt of stem cell transplantation. Results: We evaluated 1040 hospitalizations after the diagnosis of AML in 329 unique patients. The median age was 69.9 years [range 60-90] and the median number of hospitalizations was 4.2 [range 0-18]. 33.1% (109/329) of patients underwent stem cell transplantation. The most common primary reasons for hospitalizations were: fever/infection (38.0%), planned hospitalizations for chemotherapy or transplantation (37.7%), and uncontrolled symptoms (9.8%). We identified 180/1040 hospitalizations (17.4%) as potentially avoidable; among these, 47.8% were due to premature hospital discharge, 18.9% could have been managed in the outpatient setting, and 16.1% were due to failure of timely outpatient follow-up. Potentially avoidable hospitalizations represented 12.9% (76/589) and 23.1% (10/451) of hospitalizations among patients who received intensive chemotherapy and non-intensive chemotherapy, respectively. In multivariate logistic regression analysis, the receipt of non-intensive chemotherapy was associated with higher risk of potentially avoidable hospitalization [OR 2.01, 95% CI 1.27-3.20, P = 0.003]. Conclusions: Although many hospitalizations in older patients with AML are unavoidable and driven by the illness course and its treatment, a substantial proportion are potentially avoidable. Patients with AML undergoing non-intensive chemotherapy are at hi