Abstract
In order to contain costs, MDs must first identify the clinical factors contributing to increased resource utilization associated with an autologous stem cell transplant.
We performed a retrospective clinical and cost analysis of all autologous transplants performed at Dartmouth- Hitchcock Medical Center over a 30 month period (2002-2004) and identified patients who had a prolonged length of stay > 25 d (PLOS). We pinpointed the clinical characteristics and hospital course of each patient to identify trends. The hospital cost-accounting system highlighted resource utilization and costs of the transplants, allowing a comparison between patients with a PLOS and all other transplant patients.
PROLONGED LENGTH OF STAY (PLOS)
Results: All Patients LOS < 25 days LOS > 25 days # of patients 87(100%) 58 (67%) 29 (33%) LOS (days) Mean (Median) 24 (22) 20 (20) 31 (31) DISEASE (n = no. of patients) AML 14 9 5 HD/NHL 44 24 20 MM 28 25 3 Other (ITP) 1 1 ENGRAFTMENT (median) ANC > 500 (Platelets > 20K) 12 (18) 11 (16) 13 (27) TRANSFUSIONS UNITS /PT (median) RBC /Platelets > 20 4 (3) 3 (2) 7 (7) PARENTAL NUTRITION (TPN) # of days (median) 9 6 14 TOXICITIES >= GRADE 3 NCI (Common Toxicitity Criteria) Nausea and Vomiting 36% 77% Diarrhea 9% 45% Mucositis 36% 41% Anorexia 57% 83% INFECTION RATE 10% 34% ICU TRANSFER 3% 3%
Major contributors to costs included nursing/daily room charge costs (39%), pharmacy (39%), Blood Bank (6%), Laboratory (12%), and other costs (3%). The average daily costs are $4252.
The PLOS cohort had grade > 3 toxicity, increased infection rate, engrafted later and required more transfusional support. 1 pt was transferred to the ICU for temporary management. Of the 29 patients identified with PLOS, none died and all were discharged from the hospital. 45% of NHL/HD patients experienced a prolonged LOS, representing 68% of the PLOS cohort. The median LOS<25d is 20d and the median LOS>25d is 30.5d. At an average daily cost of $4252, these additional 10.5 days of hospitalization costs are substantial. Based on these findings, identification of factors underlying PLOS in the NHL/HD cohort may provide the key to minimizing cost of autologous stem cell transplant. Accordingly, we are assessing the impact of age, number of pre-transplant treatment regimens, number of peripheral blood stem cells reinfused, use of IL-2 for post-transplant immune modulation, and the day 15 absolute lymphocyte count on LOS in this population.
Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes
