Volume - Outcome Relationships in Pediatric Acute Lymphoblastic Leukemia: Association between Hospital Pediatric and Pediatric Oncology Volume with Mortality and Intensive Care Resources during Initial Therapy

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2016-07, Vol.16 (7), p.404-410.e1
• Main Authors: Wilkes, Jennifer J., MD MSCE, Hennessy, Sean, PharmD, PhD, Xiao, Rui, PhD, Rheingold, Susan, MD, Seif, Alix E., MD MPH, Huang, Yuan-Shung, Vendetti, Neika, MPH, Li, Yimei, PhD, Bagatell, Rochelle, MD, Aplenc, Richard, MD PhD, Fisher, Brian T., DO MSCE
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Critical Care - statistics & numerical data; Female; Health Resources - statistics & numerical data; Hematology, Oncology and Palliative Medicine; Hospital Mortality; Hospitalization - statistics & numerical data; Hospitals; Humans; Infant; Infant, Newborn; Leukemia; Male; Odds Ratio; Outcome Assessment (Health Care); Patient volume; Pediatric; Population Surveillance; Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Retrospective Studies
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2016.04.016

Abstract Background There are few contemporary studies of volume-outcome relationships in pediatric oncology. Children with acute lymphoblastic leukemia (ALL) are treated at wide variety of hospitals. We investigated if inpatient hospital volume influences outcomes. Objectives To evaluate the relationship between inpatient pediatric and pediatric oncology volume and mortality and intensive care resources (ICU care). We hypothesized an inverse relationship between volume and these outcomes. Research Design Retrospective Cohort Study Subjects Patients 0-18 years in the Pediatric Health Information System (PHIS) or Perspective Premier Database (Premier) from 2009-2011 with ALL. Exposures Average inpatient pediatric and pediatric oncology volume. Main outcome measures The primary outcome was inpatient mortality; secondary outcome was need for intensive care resources. Results Three thousand three hundred and fifty patients from 75 hospitals were included. The inpatient mortality rate was 0.86% (95% CI [0.58%, 1.2%]). In the unadjusted analysis, mortality increased as pediatric oncology volume increased from low (0%) to high volume (1.3%) (p=0.009). The small number of deaths precluded multivariable analysis of this outcome. Pediatric and pediatric oncology volume was not associated with ICU care when controlling for potential confounders. Conclusions Induction mortality was low. We did not observe an inverse relationship between volume and mortality or ICU care. This suggests that in a modern treatment era, treatment at a low volume center may not be associated with increased mortality or ICU care in the first portion of therapy. This relationship should be evaluated in other oncology populations with higher mortality rates and with longer-term outcomes.