Trends and Outcomes of Venous Thromboembolism in Hospitalized Patients with Pancreatic Cancer: Results from National Inpatient Sample Database 1998-2016

Introduction: Pancreatic cancer (PC) has a known association with venous thromboembolism (VTE), with incidence of approximately 17%. There is limited published data about trends and outcomes of PC patients with VTE. The purpose of this study was to describe the prevalence and mortality trends in PC with VTE and analyze VTE impact on hospitalized PC patients from 1998 to 2016. Methods: We analyzed data from the National Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). Adults≥18 years with PC as well as presence of VTE were identified by using ICD-9 or ICD-10 codes. Cost of hospitalization was adjusted for inflation in reference to 2016. Comorbidities were classified using the Elixhauser comorbidity index. Demographic characteristics, trends and in-hospital outcomes between PC with and without VTE were compared. Multiple logistic regression was used to obtain risk-adjusted odds ratio (OR) to compare inpatient mortality, length of stay (LOS), total charges, and disability at discharge between PC patients with and without VTE. The regression model was adjusted for age, sex, primary expected payer, teaching status of the hospital, hospital location, and presence of comorbid conditions. Results: 96,777 (6.5%) of a total of 1,488,543 hospitalized PC patients had an accompanying diagnosis of VTE. Mean age of the study population was 67 years. African Americans, younger age, and metastatic disease are associated with higher VTE prevalence rate. After adjusting for potential confounders, compared with those without VTE, PC patients with VTE had significantly higher inpatient mortality (12.6% vs 9.7%; OR, 1.41 [confidence interval (CI), 1.34-1.49]; P<0.001), longer LOS (8.04 vs 7.98 days; OR, 1.27 [CI, 1.23-1.32]; P<0.001), higher average cost of hospitalization (US $71,332 vs US $57,117; OR, 1.4 [CI, 1.34-1.46]; P<0.001), and greater likelihood of moderate to severe disability (defined as any beyond routine home discharge; ranging from short-term stay to skilled nursing facility to death upon discharge) (62.2% vs 50.6%, OR, 1.71 [CI, 1.65-1.78]; P<0.001). Although the annual prevalence of VTE among PC increased from 2.1% to 8.8%, in-hospital mortality declined from 23.3% in 1998 to 12.9% in 2016 (P<0.001). Conclusion: In the NIS cohort of hospitalized patients with PC and VTE from 1998-2016, annual prevalence increased while mortality overall decreased. When compared to patients without VTE, PC patients with VTE had higher inpatient mortality, longer length of stay, higher hospital cost and higher degree of disability upon discharge. Consideration for anticoagulation and interventions to limit VTE in PC patients may improve in-hospital outcomes. Figure Disclosures No relevant conflicts of interest to declare.

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The Epidemiology and Clinical Associations of Stroke in Patients with Acute Myeloid Leukemia: A Review of 10,972 Admissions from the 2012 National Inpatient Sample

Blood ◽

10.1182/blood.v126.23.1314.1314 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1314-1314

Author(s):

Taeha Kim ◽

Joseph Shatzel ◽

Harley Friedman ◽

Frederick Lansigan

Keyword(s):

Mechanical Ventilation ◽

Renal Failure ◽

Acute Renal Failure ◽

Length Of Stay ◽

Myeloid Leukemia ◽

Hospitalized Patients ◽

National Database ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Clinical Associations

Abstract Background: Patients withacute myeloid leukemia (AML) are at increased risk for both hemorrhage and thrombosis, including in the central nervous system. There is limited data on the incidence, clinical association and mortality associated with cerebrovascular accident (CVA) in hospitalized patients with active AML. The aim of this study is to evaluate the epidemiology and mortality of hospitalized patients with AML who suffered concurrent stroke from a large national database. Methods: Using the 2012 National Inpatient Sample (NIS), admissions with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for AML without remission and AML in relapse (205.00 and 205.02, respectively) were extracted, and correlated with age, gender, length of stay and mortality. All CVA (ICD-9-CM 434.91) data were extracted as well for comparison of mortality, length of stay (LOS). Results: Of the 7,296,968 unweighted admissions in the 2012 NIS, 9384 involved AML patients who had not yet achieved remission, and 1600 involved relapsed AML (Prevalence of 0.12% and 0.021% respectively). Of the combined group of admitted patients with active AML (N=10,984), 65 patients (0.59%) had a concomitant CVA (either hemorrhagic or ischemic, of whom 56 (0.51%) had active disease and 9 (0.08%) had relapsed disease). Compared to all other active AML patients, those who developed stroke were older (Mean age 66 y/o vs 58 y/o P=0.003), had longer LOS (20 days vs 12 days P= 0.53), were predominantly female (55% vs 45%; p=0.078) and had significantly higher inpatient mortality rates (36.9% vs 10.5%; OR 3.5; 95%CI 2.2, 5.5; P<0.0001). AML patients with CVA had significantly higher inpatient mortality then all admitted patients with stroke (36.9% vs 6.7%; OR 5.5; 95%CI 3.5, 8.8; P<0.0001). Multivariate logistic regression attempting to find significant clinical associations in AML patients who develop stroke, after controlling for confounding variables, found that acute renal failure with tubular necrosis(OR 4.47; 95%CI 1.8, 11.2; P=0.0013), hypernatremia (OR 3.85; 95%CI 1.6, 9.1; P=0.002), urinary tract infection (OR 3.28; CI95% 1.8, 6.1; P=0.0002) and secondary thrombocytopenia (OR 2.92; 95%CI 1.5, 5.7; P=0.0018) were all significantly predictive, as were mechanical ventilation >96 hours (OR 4.92; CI95% 1.02, 23.6; P=0.047) and continuous positive airway pressure ventilation (OR 3.03; CI95% 1.11, 8.26; P=0.031). Disseminated intravascular coagulation (DIC) and leukocytosis were more prevalent in AML patients with CVA compare to all AML patients, but the difference did not reach statistical significance. Conclusions: CVA in patients with active AML was strongly associated with older age and higher mortality, and appeared to be a relatively rare event, occurring in only 0.59% of patients. There was no statistically significant difference in LOS or gender distribution between those who developed CVA and those who did not amont active AML patients. As compared to all CVA patients, active AML patients with CVA had 5-fold higher risk of mortality. Significant acute renal failure, hypernatremia and thrombocytopenia appear to portend a higher risk of stroke in patients with active AML. It is unclear if UTI, and the need for mechanical ventilation is a predictor of stroke, as much as they may be a ramification of it. While more common in AML patients with CVA vs AML patients without CVA, we did not find DIC or hyperleukocytosis to be significantly predictive. Disclosures No relevant conflicts of interest to declare.

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Trends, Predictors and Outcomes of Portal Vein Thrombosis in Hospitalized Pancreatic Cancer Patients: National Inpatient Sample Analysis 1998-2016

Blood ◽

10.1182/blood-2019-129612 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4949-4949

Author(s):

Hussam Alhasson ◽

Peng Cai ◽

Zimu Gong ◽

Anas Saad ◽

Muneer Al-Husseini ◽

...

Keyword(s):

Pancreatic Cancer ◽

Length Of Stay ◽

Portal Vein ◽

Hospital Mortality ◽

Portal Vein Thrombosis ◽

Prevalence Rate ◽

Regression Models ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Vein Thrombosis

Introduction: Portal vein thrombosis (PVT) is usually associated with intra-abdominal malignancies, particularly pancreatic cancer (PC). PVT prevalence rate and impact on outcome of PC patients are not well studied, especially on a large scale of cohort. We described the prevalence and mortality trends of PVT amongst PC patients and analyzed their demographic characteristics. We also studied the impact of PVT with PC on hospitalization outcomes. Methods: We queried the 1998-2016 National Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). Hospitalized adult patients (age≥18 years) with diagnosis of PC as well as presence of PVT were identified by using ICD-9 or ICD-10 codes. Cost of hospitalization was adjusted for inflation in reference to 2016. Comorbidities were classified using the Elixhauser comorbidity index. We used linear regression models to analyze trends in prevalence and outcomes over time. Logistic regression models were generated to evaluate multivariate predictors of length of stay (LOS), total charges, mortality, and complications in PC patients with and without PVT. The regression model was adjusted for age, sex, primary expected payer, teaching status of the hospital, hospital location, comorbid conditions, and presence of venous thromboembolism (VTE). Results: Among a total of 1,488,543 hospitalized PC patients, 19,725 (1.3%) experienced PVT. Mean age was 68 years. Hispanic Americans, younger age, teaching hospital, urban hospital and metastatic disease were associated with higher PVT prevalence rate. Interestingly, VTE prevalence in PC patients with and without PVT were 11% and 6% respectively, P<0.001. After adjusting for potential confounders, compared with those without PVT, PC patients with PVT had significantly higher inpatient mortality (10.5% vs 9.9%; odds ratio (OR), 1.16 [confidence interval (CI), 1.03-1.30]; P=0.013), longer LOS (8.29 vs 7.03 days; OR, 1.27 [CI, 1.19-1.36]; P<0.001), higher average cost of hospitalization (US $81,858 vs US $57,722; OR, 1.54 [CI, 1.43-1.67]; P<0.001), and greater likelihood of moderate to severe disability (defined as any beyond routine home discharge; ranging from short-term stay to skilled nursing facility to death upon discharge)(55.9% vs 51.3%, OR, 1.4 [CI, 1.31-1.50]; P<0.001). Although the annual prevalence of PVT among PC increased from 0.3% to 3.0% (p<0.001), in-hospital mortality declined significantly from 29.2% in 1998 to 8.0% in 2016 (p<0.001). Conclusion: In retrospective analysis of the NIS cohort of hospitalized patients with PC and PVT from 1998-2016, the prevalence increased by 10 folds. However, in-hospital mortality decreased significantly. Compared to those without PVT, patients with PC with PVT had higher inpatient mortality, longer length of stay, higher hospital cost and higher degree of disability upon discharge. Further studies are warranted to reveal a certain subgroup of PC patients who may benefit from prophylactic anticoagulation. Figure Disclosures No relevant conflicts of interest to declare.

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Trends and Outcomes of Venous Thromboembolism in Hospitalized Patients With Ovarian Cancer: Results From Nationwide Inpatient Sample Database 2003 to 2011

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001335 ◽

2018 ◽

Vol 28 (8) ◽

pp. 1478-1484 ◽

Cited By ~ 2

Author(s):

Varun Mittal ◽

Shradha Ahuja ◽

Sai Sharath Vejella ◽

Jessica M. Stempel ◽

Venkataraman Palabindala ◽

...

Keyword(s):

Ovarian Cancer ◽

Venous Thromboembolism ◽

Length Of Stay ◽

Cancer Patients ◽

Nationwide Inpatient Sample ◽

Hospitalized Patients ◽

Annual Number ◽

Binary Logistic Regression Analysis ◽

Inpatient Mortality ◽

Nationwide Inpatient Sample Database

ObjectiveVenous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients with malignancy. Nationwide Inpatient Sample database was analyzed to determine the trends in the rate of hospitalization and mortality from VTE in hospitalized ovarian cancer patients and assess its economic impact and resource utilization.MethodWe queried the 2003 to 2011 Nationwide Inpatient Sample database from Healthcare Cost and Utilization project (Agency of Healthcare Research and Quality) to identify all adults (age ≥18 years) ovarian cancer. Patients hospitalized with VTE as one of the top 3 discharge diagnoses were also identified. Demographic characteristics and in-hospital outcomes of this population were compared with ovarian cancer patients without VTE. Binary logistic regression analysis was used to obtain adjusted odds ratios (ORs).ResultsA total of 34,249 (3.5%) of a total of 981,386 hospitalized ovarian cancer patients had an accompanying diagnosis of VTE. Mean age of the study population was 64 years. After adjusting for potential confounders, compared with those without VTE, ovarian cancer patients with VTE had significantly higher inpatient mortality (6.2% vs 4.3%; OR, 1.12 [confidence interval (CI), 1.06–1.17]; P < .001), longer length of stay (5 vs 4 days; OR, 1.40 [CI, 1.36–1.43]; P < .001), higher average cost of hospitalization (US $26,000 vs US $22,000; OR, 1.10 [CI, 1.07–1.13]; P < .001), and greater disability at discharge (OR, 1.34 [CI, 1.31–1.38]; P < .001). Although the annual number of VTE admissions in ovarian cancer patients increased, in-hospital mortality declined from 10.9% in 2003 to 5.3% in 2011.ConclusionsVenous thromboembolism in hospitalized patients with ovarian cancer is associated with higher inpatient mortality, length of stay, higher cost of hospitalization, and disability at discharge. The hospitalization rate has increased, but the inpatient mortality rate has declined over study period.

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Abstract 17024: Venous Thromboembolism (VTE) Mortality Trends in the Pediatric Population: A Retrospective Analysis of the National Inpatient Sample (NIS) Database

Circulation ◽

10.1161/circ.138.suppl_1.17024 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Juan P Salazar Adum ◽

Iva Golemi ◽

Alfonso J Tafur

Keyword(s):

Venous Thromboembolism ◽

Retrospective Analysis ◽

Pediatric Population ◽

Hospitalized Patients ◽

Coding System ◽

National Inpatient Sample ◽

Mortality Trends ◽

Cohort Group ◽

The Us ◽

Simple Logistic

Background: Venous thromboembolism (VTE) is one of the leading preventable cardiovascular diseases and responsible for approximately 300,000 deaths per year in the US. There is paucity of data regarding mortality secondary to VTE in the pediatric population. Aim: To determine the mortality trends due to VTE in hospitalized patients among the pediatric population. Methods: We perform a retrospective analysis of the National Inpatient Sample (NIS) database. The cohort group consisted in hospitalized patients under the age of 18 with a diagnosis of VTE. We used the ICD-9 coding system to identify the diagnosis of VTE. Patients were included only if VTE was considered within the first four discharge diagnoses. We used simple logistic regression to calculate trends. All statistical analyses were performed in SPSS software version 22. Chicago, Illinois. Results: A total of 4961 (not weighted) patients (female: 2567 (51.7%), mean age: 12.19 (SD=5.7), neonate to infant: 553 (11.1%), toddler: 173 (3.5%), preschool: 197 (4%), school: 751 (15.1%), adolescent: 3287 (66.3%)) were included. The prevalence of VTE by age group showed a J-shaped curve and was more commonly seen among adolescents. Fig. 1. A total of 93 patients died (1.9%). Pulmonary embolism (PE) occurred in 1835 patients (36.5%). Among patients with PE, 4.4% died compared to 0.4% with non-PE (OR: 10.9 95% CI 5.8-18.1, p: <0.001). No trend in mortality was observed over a period of 10 years p: 0.19. Fig. 2. Conclusion: The inpatient mortality rate secondary to VTE among pediatric patients is low. Patients with PE have a 11-fold increased mortality likelihood compared to non-PE patients. No mortality trends were observed.

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Impact of Pulmonary Hypertension on in-hospital outcomes amongst Sickle Cell Disease hospitalizations

Blood ◽

10.1182/blood-2020-141483 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 6-7

Author(s):

Khushali Jhaveri ◽

Raj Patel ◽

Christopher Barnett ◽

Hedy Smith

Keyword(s):

Pulmonary Hypertension ◽

Venous Thromboembolism ◽

Sickle Cell Disease ◽

Length Of Stay ◽

Sickle Cell ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cell Disease ◽

Hospital Outcomes ◽

The Impact

Introduction: Pulmonary hypertension (PH) is a common and severe complication of Sickle Cell Disease (SCD), and an independent risk factor for mortality. While there is a clear association between SCD and PH, the predictors of PH in SCD and the impact of PH on in-hospital outcomes of SCD hospitalizations remains unknown. In our study, we sought to assess the in-hospital prevalence, predictors, and the impact of PH in SCD hospitalizations. Methods: We used the 2016 and 2017 National Inpatient Sample (NIS) to identify all adult hospitalizations with a primary discharge diagnosis of SCD. The sample was then stratified based on the presence or absence of PH. We used the Pearson chi-square test and weighted Student's t-test to analyze categorical and continuous variables, respectively. Multivariate logistic regression analysis was performed to calculate the adjusted odds ratio for various clinical outcomes. SAS was used for the analysis, and the p-value was defined as <0.05. Results: We identified n=191,080 weighted hospitalizations for SCD, of which, 5.54% (n=10590) had concomitant PH. Female gender and comorbidities including hypertension, obesity, illicit drug use, hepatic cirrhosis, renal failure, prior venous-thromboembolism, valvular, and congenital heart disease were identified as significant predictors of PH in SCD. PH was associated with increased in-hospital mortality (1.04% vs 0.22%, AOR=2.14, 95% CI 1.15-3.98, p=0.0158). PH in SCD hospitalizations also increased the odds of - acute kidney injury (AKI), need for dialysis, acute respiratory failure (ARF), and need for mechanical ventilation for > 96 hours. The adjusted odds ratio for venous thromboembolism, shock-state, and the need for cardiac catheterization (both right and bilateral) were also higher in patients with PH. Overall hospitalization cost and length of stay increased (7.06±0.16 vs 1.82±0.02 days) in patients with SCD and PH (see table 1). Conclusion: In sickle cell disease hospitalizations, PH is independently associated with increased in-hospital morbidity and mortality, with an increased need for in-hospital catheterizations thereby, prolonging the length of stay and overall health care costs. Identifying and treating PH in the SCD population would improve in-hospital outcomes. Disclosures No relevant conflicts of interest to declare.

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Pengaruh Perubahan Status Gizi Pasien Dewasa terhadap Lama Rawat Inap dan Biaya Rumah Sakit

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.15359 ◽

2004 ◽

Vol 1 (1) ◽

pp. 35

Author(s):

R Dwi Budiningsari

Keyword(s):

Length Of Stay ◽

Nutritional Status ◽

Global Assessment ◽

Reference Group ◽

Hospital Charge ◽

Hospitalized Patients ◽

Adult Patients ◽

Hospital Charges ◽

Subjective Global Assessment ◽

Hospital Outcomes

Background: The decline in nutritional status of hospitalized patients was reported to be assossiated with longer length of stay and higher hospital charges. However, the effect of changes in nutritional status on hospital outcomes in Indonesia is still unknown.Objective: To determine the effect of changes in nutritional status on length of stay and hospital charge among adult hospitalized patients.Method: A total subjects of 262 adult patients who were admitted to internal and neurology departments of Dr. Sardjito, Dr.M.Jamil, and Sanglah hospitals were included in this study. Nutritional status of each patient was assessed using Subjective Global Assessment (SGA) method. Information on length of stay and hospital charge was collected based on medical records.Results: Subjects with nutritional status declined from normally to moderately, normally to severely, and moderately to severely malnourished were 6,3 (OR=6.32, 95% CI=1,3-29,8); 11,9 (OR=11.94, 95% CI=1,02-139,1); and 6,90 (OR=6.9, 95%CI=1,5-32,0 )times more likely to stay longer than those with nutritional status stayed normal during hospitalitation. They also had 3,3; unlimited; and 1,76 times risk on higher hospital charges than reference group (95% CI=1,123-9,529; unlimited; and 0,590-5,245).Conclusions: The declines of nutritional status from normally to moderately, normally to severely, and moderately to severely malnourished in hospitalized patients influenced to longer length of stay. Normally to moderately and normally to severely malnourished in hospitalized patients influenced to higher hospital charges.

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Sickle Cell Disease and Venous Thromboembolism: Hospital Mortality, Length of Stay and Cost

Blood ◽

10.1182/blood-2018-99-119778 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 2378-2378

Author(s):

Michael Rainone ◽

Stuthi Pavani Perimbeti ◽

Rishi Shrivastav ◽

Jeffrey A. Glassberg ◽

Lawrence Cytryn

Keyword(s):

Venous Thromboembolism ◽

Sickle Cell Disease ◽

Length Of Stay ◽

Sickle Cell ◽

Treatment Guidelines ◽

Conflicts Of Interest ◽

Primary Diagnosis ◽

Cell Disease ◽

Chi Square ◽

Blood Institute

Abstract Introduction: It is estimated that there are 100,000 Americans living with Sickle Cell Disease (SCD). Patients with SCD experience a number of complications that frequently require hospitalization. SCD is a prothrombotic state that is commonly complicated by venous thromboembolism (VTE) and recurrent VTE. The National Heart, Lung and Blood Institute do not include VTE as one of the complications of SCD in their latest guidelines, and the topics of prophylaxis and treatment of VTE in SCD are not discussed. There are no guidelines specifically designed for the prophylaxis or treatment of VTE in the SCD population, and traditionally management guidelines for VTE in the general population are followed. Recent information on national prevalence, mortality, length of stay, and cost for hospitalized patients with with SCD complicated by VTE is limited. Methods: We used data from the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) from 1999-2014 to examine these variables. The data on SCD from 1999-2014 was analyzed using ICD-9-CM codes for SCD (ICD-9-CM: 282.41, 282.42, 282.6, 282.60, 282.62, 282.63, 282.64, 282.68, 282.69) in the primary diagnosis field, and VTE (ICD-9-CM: 453.40, 453.41, 453.42, 453.82, 453.83, 415.11, 415.19) in the secondary diagnosis field which includes codes for venous thrombosis and pulmonary embolism. Univariate and bivariate statistical analysis was performed using the chi-square test. Multivariate analysis was performed using cox proportional hazard regression. The alpha was set at 0.05. Results: Over a 15 year period, from 1999-2014, a total of 217,791 (weighted N = 1,073,215) admissions with SCD were identified. A total of 7,898 admissions were associated with VTE. Mean age at admission of those with VTE was 27.42 (+/- 0.05) years and those without VTE was 34.00 (+/- 0.51) years. In patients with SCD and VTE, the average inpatient mortality was 3.08% (p < 0.0001) versus mortality of 0.27% in patients that did not have VTE. The hazard ratio for mortality was 4.18 (CI: 2.95-5.93) (p < 0.0001). Length of stay in the SCD with VTE group was 10.45 days (+/- 0.43) versus 5.09 days (+/- 0.02) (p < 0.0001) in SCD without VTE. Overall hospital cost was higher in those with VTE at $60,055 (+/- $1,940) versus $28,729 (+/- 232.97) (p < 0.0001) in those without VTE. Conclusions: Patients with SCD and VTE experience significant morbidity, mortality, prolonged hospitalization and increased cost associated with this complication of the disease as was observed in this study. Furthermore, patients who experience VTE are significantly younger than those who do not, with mean age of 27 versus 34. After controlling for multiple confounders like age, race, sex, income, comorbidities, the presence of VTE is associated with a significantly higher risk of mortality in SCD. Currently, there are no prophylaxis or treatment guidelines designed specifically for patients with SCD and VTE. We recommend the use of antithrombotic prophylaxis or therapy in patients with SCD be evaluated in prospective studies. Disclosures No relevant conflicts of interest to declare.

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Trends in Inpatient Chemotherapy Hospitalizations, Cost and Mortality for Patients with Hematological Malignancies: Insights from the National Inpatient Sample

Blood ◽

10.1182/blood-2020-142978 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 53-54

Author(s):

Ghulam Rehman Mohyuddin ◽

Kellen Gil ◽

Brian McClune ◽

Nausheen Ahmed ◽

Al-Ola Abdallah ◽

...

Keyword(s):

Multiple Myeloma ◽

Length Of Stay ◽

Myeloid Leukemia ◽

Research Funding ◽

Hematological Malignancies ◽

Mortality Rates ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Lymphoid Leukemia ◽

Acute Myeloid

INTRODUCTION: With the advent of newer treatment options for patients with acute leukemia and myeloma, therapies are increasingly safely administered on an outpatient basis. We hypothesized increasing utilization of outpatient options would result in decreased hospitalizations for chemotherapy, albeit with increased hospitalization charges. We interrogated chemotherapy utilization amongst adult inpatients with these malignancies using the National Inpatient Sample (NIS). METHODS: The NIS is a database providing information on all inpatient hospitalizations in the United States (US), including primary and secondary diagnoses, procedures, length of stay, and disposition. Approximately 20% of admissions are tracked, and weighted estimates are provided regarding the total number of hospitalizations in the US. Using the NIS, we tracked chemotherapy admissions for patients with the following hematological malignancies: acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and multiple myeloma (MM). Admissions for hematopoietic stem cell transplants were excluded from our analysis, and only patients aged 18 or greater were included in our analysis. Procedural International Classification of Disease (ICD) 9 and 10 codes were used to gain insight into trends of hospitalizations, elective versus urgent status, costs and length of stay for each indication. Time frame 2002-2017 was chosen as this was the most recent year for which NIS data is available. Inflation adjustments for charges were calculated based on US Department of Labor statistics. RESULTS: For MM, there were a total of 54,357 admissions for chemotherapy from 2002-2017. Amongst these admissions, 37,517 were elective, and 16,670 were non-elective, with the remainder lacking data on elective status. Figure 1 highlights trends in admissions for MM, with a significant decrease noted in the overall volume (7,547 in 2002 to 2,710 in 2014 (p=0.003)). Mortality rates for MM chemotherapy admissions, also highlighted in Figure 1, did not change significantly from 2002 to 2017 (p=0.15). Mean length of stay for chemotherapy hospitalizations increased from 4.67 days in 2002 to 6.47 days in 2017 (p<0.0001). Mean inflation-adjusted hospitalization charges increased from $20,865 in 2002 to $79,161 in 2017 (p<0.0001). For AML, we noted 198,288 admissions for chemotherapy from 2002-2017 of which 127,277 were considered elective, and 70,566 non-elective, with the remainder lacking data on elective status. Figure 2 highlights trends in AML admissions with a decreased volume of admissions noted from 2011 onwards after an initial increase from 2005-2008. There was a total of 14,214 admissions in 2011 compared to 10,515 in 2017 (p=0.004) There was a decrease in inpatient mortality rates from 5.5% in 2002 to 2.4% in 2017 (p<0.0001). Mean length of stay was consistent during this time period from 13.35 days in 2002 to 13.34 days in 2017 (p=0.15). Mean inflation-adjusted hospitalization charges increased from $83,904 in 2002 to $133,295 in 2017 (p<0.001). There was a total of 82,730 admissions for chemotherapy from 2002-2017 for ALL. Amongst these admissions, 54,565 were elective and 27,963 were non-elective, with the remainder lacking data on elective status. Figure 3 highlights trends in admissions, with an increase in number of admissions from 4,092 in 2002 to 5,960 in 2017 (p=0.86). There was a decrease in the inpatient mortality rate from 0.8% in 2002 to 0.4% in 2017 (p=0.0007). Mean length of stay stayed consistent at 7.70 days in 2002 to 7.62 days in 2017 (p=0.06). Mean inflation-adjusted hospitalization charges increased from $49,283 in 2002 to $94,787 in 2017 (p<0.0001). CONCLUSIONS: There has been a steady decline in the number of admissions for inpatient chemotherapy for patients with multiple myeloma and acute myeloid leukemia over time, owing to advances in therapies delivered safely and efficaciously as an outpatient. There has also been a steady decline in inpatient mortality for chemotherapy for acute myeloid and acute lymphoid leukemia, in part due to advances in supportive care. However, the inpatient mortality rate for myeloma has not decreased, likely due to sicker patients preferentially needing admission for inpatient chemotherapy. Inflation-adjusted hospitalization charges have gone up dramatically and further work is needed to elucidate factors driving these costs, and how to mitigate them. Disclosures Ganguly: Kadmon: Other: Ad Board; Settle Genetics: Speakers Bureau; KITE Pharma: Speakers Bureau. McGuirk:Astellas: Research Funding; Novartis: Research Funding; Allo Vir: Consultancy, Honoraria, Research Funding; Juno Therapeutics: Consultancy, Honoraria, Research Funding; Kite Pharmaceuticals: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pluristem Ltd: Research Funding; Gamida Cell: Research Funding; Bellicum Pharmaceutical: Research Funding; Fresenius Biotech: Research Funding.

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