Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

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Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states

Journal of Neurosurgery ◽

10.3171/jns.2003.99.5.0810 ◽

2003 ◽

Vol 99 (5) ◽

pp. 810-817 ◽

Cited By ~ 162

Author(s):

DeWitte T. Cross ◽

David L. Tirschwell ◽

Mary Ann Clark ◽

Dan Tuden ◽

Colin P. Derdeyn ◽

...

Keyword(s):

Emergency Department ◽

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Hospital Volume ◽

High Volume ◽

Mortality Rates ◽

Case Volume ◽

Content Type ◽

Hospital Case ◽

Fine Print

Object. The goal of this study was to determine whether a hospital's volume of subarachnoid hemorrhage (SAH) cases affects mortality rates in patients with SAH. For certain serious illnesses and surgical procedures, outcome has been associated with hospital case volume. Subarachnoid hemorrhage, usually resulting from a ruptured cerebral aneurysm, yields a high mortality rate. There has been no multistate study of a diverse set of hospitals to determine whether in-hospital mortality rates are influenced by hospital volume of SAH cases. Methods. The authors conducted an analysis of a retrospective, administrative database of 16,399 hospitalizations for SAH (9290 admitted through emergency departments). These hospitalizations were from acute-care hospitals in 18 states representing 58% of the US population. Both univariate and multivariate analyses were used to assess the case volume—mortality rate relationship. The authors used patient age, sex, Medicaid status, hospital region, data source year, hospital case volume quartile, and a comorbidity index in multivariate generalized estimating equations to model the relationship between hospital volume and mortality rates after SAH. Patients with SAH who were treated in hospitals in which low volumes of patients with SAH are admitted through the emergency department had 1.4 times the odds of dying in the hospital (95% confidence interval 1.2–1.6) as patients admitted to high-volume hospitals after controlling for patient age, sex, Medicaid status, hospital region, database year, and comorbid conditions. Conclusions. Patients with a diagnosis of SAH on their discharge records who initially presented through the emergency department of a hospital with a high volume of SAH cases had significantly lower mortality rates. Concentrating care for this disease in high-volume SAH treatment centers may improve overall survival.

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Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part II: management and surgical outcome

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.0967 ◽

2000 ◽

Vol 93 (6) ◽

pp. 967-975 ◽

Cited By ~ 46

Author(s):

Tetsuji Inagawa ◽

Masaaki Shibukawa ◽

Futoshi Inokuchi ◽

Yoshio Tokuda ◽

Yoshikazu Okada ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Survival Rates ◽

Case Fatality ◽

Epidemiological Studies ◽

Day Case ◽

Content Type ◽

Gcs Score ◽

Fine Print

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.Conclusions. The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.

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Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2013.9.jns13640 ◽

2014 ◽

Vol 120 (3) ◽

pp. 605-611 ◽

Cited By ~ 34

Author(s):

Hieronymus D. Boogaarts ◽

Martinus J. van Amerongen ◽

Joost de Vries ◽

Gert P. Westert ◽

André L. M. Verbeek ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Mortality ◽

Random Effects ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Relative Weight ◽

High Volume ◽

Cochrane Library ◽

Endovascular Coiling ◽

Low Volume

Object Increasing evidence exists that treatment of complex medical conditions in high-volume centers is found to improve outcome. Patients with subarachnoid hemorrhage (SAH), a complex disease, probably also benefit from treatment at a high-volume center. The authors aimed to determine, based on published literature, whether a higher hospital caseload is associated with improved outcomes of patients undergoing treatment after aneurysmal subarachnoid hemorrhage. Methods The authors identified studies from MEDLINE, Embase, and the Cochrane Library up to September 28, 2012, that evaluated outcome in high-volume versus low-volume centers in patients with SAH who were treated by either clipping or endovascular coiling. No language restrictions were set. The compared outcome measure was in-hospital mortality. Mortality in studies was pooled in a random effects meta-analysis. Study quality was reported according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Results Four articles were included in this analysis, representing 36,600 patients. The quality of studies was graded low in 3 and very low in 1. Meta-analysis using a random effects model showed a decrease in hospital mortality (OR 0.77 [95% CI 0.60–0.97]; p = 0.00; I2 = 91%) in high-volume hospitals treating SAH patients. Sensitivity analysis revealed the relative weight of the 1 low-quality study. Removal of the study with very low quality increased the effect size of the meta-analysis to an OR of 0.68 (95% CI 0.56–0.84; p = 0.00; I2 = 86%). The definition of hospital volume differed among studies. Cutoffs and dichotomizations were used as well as division in quartiles. In 1 study, low volume was defined as 9 or fewer patients yearly, whereas in another it was defined as fewer than 30 patients yearly. Similarly, 1 study defined high volume as more than 20 patients annually, and another defined it as more than 50 patients a year. For comparability between studies, recalculation was done with dichotomized data if available. Cross et al., 2003 (low volume ≤ 18, high volume ≥ 19) and Johnston, 2000 (low volume ≤ 31, high volume ≥ 32) provided core data for recalculation. The overall results of this analysis revealed an OR of 0.85 (95% CI 0.72–0.99; p = 0.00; I2 = 87%). Conclusions Despite the shortcomings of this study, the mortality rate was lower in hospitals with a larger caseload. Limitations of the meta-analysis are the not uniform cutoff values and uncertainty about case mix.

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Prediction of 60-day case fatality after aneurysmal subarachnoid hemorrhage: external validation of a prediction model

Critical Care ◽

10.1186/cc14547 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P467

Author(s):

S Dijkland ◽

B Roozenbeek ◽

P Brouwer ◽

H Lingsma ◽

D Dippel ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prediction Model ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Validation ◽

Case Fatality ◽

Day Case

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Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

Journal of Neurosurgery ◽

10.3171/2019.12.jns192468 ◽

2020 ◽

pp. 1-6

Author(s):

Enrico Giordan ◽

Christopher S. Graffeo ◽

Alejandro A. Rabinstein ◽

Robert D. Brown ◽

Walter A. Rocca ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Incidence Rate ◽

Case Fatality Rate ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Olmsted County ◽

Day Case ◽

Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

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Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia

Neurosurgery ◽

10.1093/neuros/nyy223 ◽

2018 ◽

Vol 84 (5) ◽

pp. 1019-1027 ◽

Cited By ~ 10

Author(s):

Antti Lindgren ◽

Ellie Bragan Turner ◽

Tomas Sillekens ◽

Atte Meretoja ◽

Jin-Moo Lee ◽

...

Keyword(s):

Clinical Practice ◽

Subarachnoid Hemorrhage ◽

Case Fatality Rate ◽

Randomized Clinical Trials ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tertiary Care ◽

Case Fatality ◽

Fatality Rate ◽

Administrative Dataset ◽

Clinical Dataset

Abstract BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1–2.7), for 90-d case-fatality 1.28 (95% CI 0.91–1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6–1.01). CONCLUSION In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs.

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The association between hospital case volume and in-hospital and one-year mortality after hip fracture surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2019-1728.r3 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1384-1391

Author(s):

Seokha Yoo ◽

Eun Jin Jang ◽

Junwoo Jo ◽

Jun Gi Jo ◽

Seungpyo Nam ◽

...

Keyword(s):

Hip Fracture ◽

Hospital Mortality ◽

High Volume ◽

Case Volume ◽

Hospital Case ◽

Hip Fracture Surgery ◽

Low Volume ◽

One Year ◽

Fracture Surgery ◽

Very High

Aims Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Methods Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. Results Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). Conclusion Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384–1391.

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Hospital variation in bronchoscopy and esophagoscopy rates during head and neck cancer diagnostic evaluation.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6044 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6044-6044

Author(s):

Gordon H. Sun ◽

Oluseyi Aliu ◽

Nicholas M. Moloci ◽

Joshua Keith Mondschein ◽

James F. Burke ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Primary Outcome ◽

High Volume ◽

Case Volume ◽

Hospital Case ◽

Hospital Variation ◽

Low Volume

6044 Background: Hospital variation in bronchoscopy and esophagoscopy rates while diagnosing head and neck cancer may reflect professional uncertainty about the effectiveness of these procedures and a lack of clinical guidelines on best practices. Furthermore, high-volume hospitals have demonstrated better outcomes for select oncologic procedures. We examined the association between hospital case volume and diagnostic bronchoscopy and esophagoscopy rates. Methods: This retrospective cohort study used the 2006-2010 Michigan State Ambulatory Surgery Databases, capturing all outpatient surgical cases in Michigan. Eligible cases included head and neck cancer patients who underwent laryngoscopy, bronchoscopy, and/or esophagoscopy. The primary outcome measure was the likelihood that a patient who underwent laryngoscopy during head and neck cancer diagnostic workup also underwent either bronchoscopy or esophagoscopy. We used hierarchical, mixed-effect logistic regression to measure the association between the primary outcome and hospital case volume (<100, 100-999, or ≥1,000 cases/hospital) while adjusting for patient-level variables such as age, sex, race, insurance status, and household income. Results: Of 17,828 head and neck cancer patients, 9,218 underwent diagnostic laryngoscopy. The 50 low-volume and 40 medium-volume hospitals performed significantly more concurrent bronchoscopies and esophagoscopies compared to the 2 high-volume hospitals (both p<0.001). After adjusting for patient characteristics, medium-volume and low-volume hospitals respectively had 9.3-fold and 7.8-fold higher odds of performing esophagoscopy relative to high-volume hospitals (p=0.003), although the association with bronchoscopy was no longer statistically significant. Conclusions: The proportion of head and neck cancer patients undergoing diagnostic laryngoscopy with concurrent esophagoscopy, but not bronchoscopy, varies significantly by hospital volume. A robust discussion of the comparative effectiveness of comprehensive and selective endoscopy will require further research into whether endoscopic volume correlates with tumor staging, survival, and other outcomes data.

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Prediction of 60-Day Case Fatality After Aneurysmal Subarachnoid Hemorrhage

Critical Care Medicine ◽

10.1097/ccm.0000000000001709 ◽

2016 ◽

Vol 44 (8) ◽

pp. 1523-1529 ◽

Cited By ~ 9

Author(s):

Simone A. Dijkland ◽

Bob Roozenbeek ◽

Patrick A. Brouwer ◽

Hester F. Lingsma ◽

Diederik W. Dippel ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Day Case

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Association between Transplant Volumes and 30-Day Readmissions Following Allogeneic Hematopoietic Cell Transplantation (allo-HCT) in the US

Blood ◽

10.1182/blood-2018-99-116196 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 617-617

Author(s):

Binod Dhakal ◽

Smith Giri ◽

Adam Levin ◽

Rein Lisa ◽

Timothy S. Fenske ◽

...

Keyword(s):

Research Funding ◽

High Volume ◽

Medicare Beneficiaries ◽

Case Volume ◽

Readmission Rates ◽

Stem Cell Source ◽

Co Morbidity ◽

Equity Ownership ◽

Low Volume ◽

Morbidity Index

Abstract Background: Readmissions within 30 days after index hospitalization is a quality and cost-containment metric. Financial penalties to hospitals with high rates of risk-adjusted readmissions have been expanded beyond medical conditions like heart failure and pneumonia. Published data show significant heterogeneity in readmission rates and recent data from elderly Medicare beneficiaries reported a 17.8% readmission rate for targeted conditions. Allo-HCT is a widely used therapeutic strategy in the management of various hematologic disorders like acute myelogenous (AML) and lymphoblastic leukemia (ALL). However, allo-HCT readmission rates are poorly described, and limited to single center studies only. The association between institution HCT volume and 30-day readmission metric has not been examined. Methods: In this observational study, we used the 2012-2014 Nationwide Readmission Database (NRD) to identify hospitals with established allo-HCT programs. Patients ≥18 years of age, discharged from hospital following an allo-HCT (identified using ICD-9 procedure code of 41.02, 41.03, 41.05, 41.06, or 41.08) were included. Annual hospital case volume was calculated as the sum of all discharges with allo-HCT within the calendar year; low, medium, and high annual case volume groups were created based on (survey weighted) tertiles of patients (pts.) in the analytic data domain (Figure 1). Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. The analysis was limited to urban teaching hospitals and pts. admitted during month of December were excluded. The primary outcome, was the unplanned 30-day re-admission following allo-HCT. Multiple logistic regression was used to model each 30-day readmission outcome including hospital case volume with other predictors (age, sex, disease type, stem cell source, co-morbidity index, primary insurance, length of stay, infection and acute graft-versus-host-disease (aGVHD) at index admission, discharge disposition and median income quartile). Results: A total of 17,214 (weighted) allo-HCTs were performed during the time period. Baseline characteristics of pts. in low (<58 allo-HCTs/yr.)-, medium (58-158 allo-HCTs/yr.)- and high-volume (>158 allo-HCTs/yr.) hospitals were comparable as shown in Table 1. The overall rates of readmissions were significantly higher in low volume centers (24.7.4%; SE, 1.5) compared to medium (21.4% (1.7) and high volume (9.5% (1.8), centers (p=0.03). The mean time to readmission in low vs. medium vs. high volume centers was, 11.6 [0.39] days vs. 12 [0.26] days vs. 11.5 [0.57] days respectively, (p <0.001). The length of readmission stay was significantly longer in low volume centers (mean [SD], 12.8 [0.64] days vs. 12.3 [0.91] days vs. 10.6 [0.80] days; p=<0.001) respectively. Consequently, cost per readmission was significantly higher in low volume centers (mean [SD], $164,349 [12,328] vs. $140,327 [15,297] vs. $107,362 [11,665]; p<0.001). Readmission rates in low volume and medium volume centers compared to high volume centers were: adjusted odds ratio (aOR) 1.39, 95% CI 1.08-1.77; p =0.01 and 1.18, 95% CI, 0.89-1.55; p=0.23, respectively. Other significant predictors of readmission included disease type (ALL vs. AML): aOR 1.32, 95% CI 1.07-1.63; p= 0.009), type of primary insurance (Medicare vs. private): aOR 1.17, 95% CI 1.01-1.35; p=0.02; Elixhauser co-morbidity index (≥1 vs. 0): aOR 1.4, 95% CI 1.2-1.7; p= 0.001 and stem cell source (cord blood vs. peripheral blood; aOR 2.4, 95%CI 1.85-3.2, p<0.001). Patients with any infection and the presence of aGVHD at index admission did not have an effect on readmission rates. Neutropenia, fever, viral infection, sepsis, acute renal failure, and pneumonia were the most common reasons for readmission. Conclusions: The likelihood of readmission after allo-HCT is elevated in centers performing <58 allo-HCTs/year, in those pts. with ≥1 co-morbidities, cord blood transplants, in ALL pts. and in Medicare beneficiaries. Lower readmission at higher-volume centers was associated with significantly lower cost to the health care system. There are important limitations with the use of data from NRD particularly the lack of information on donor status and conditioning regimen. Despite these shortcomings, the information may aid health care when developing quality-of-care metric for allo-HCT. Disclosures Dhakal: Amgen: Honoraria; Takeda: Honoraria; Celgene: Consultancy, Honoraria. Shah:Geron: Equity Ownership; Lentigen Technology: Research Funding; Juno Pharmaceuticals: Honoraria; Oncosec: Equity Ownership; Miltenyi: Other: Travel funding, Research Funding; Exelexis: Equity Ownership. D'Souza:Prothena: Consultancy, Research Funding; Takeda: Research Funding; Celgene: Research Funding; Merck: Research Funding; Amgen: Research Funding. Hari:Celgene: Consultancy, Honoraria, Research Funding; Janssen: Honoraria; Bristol-Myers Squibb: Consultancy, Research Funding; Kite Pharma: Consultancy, Honoraria; Sanofi: Honoraria, Research Funding; Amgen Inc.: Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Spectrum: Consultancy, Research Funding. Hamadani:Sanofi Genzyme: Research Funding, Speakers Bureau; MedImmune: Consultancy, Research Funding; Celgene Corporation: Consultancy; Takeda: Research Funding; Cellerant: Consultancy; ADC Therapeutics: Research Funding; Ostuka: Research Funding; Janssen: Consultancy; Merck: Research Funding.

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