Socioeconomic and clinical predictors of 30-day readmissions in AML patients undergoing allogeneic stem cell transplantation.

Abstract

6548 Background: 30-day readmissions among acute myeloid leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) are a key quality metric, contributing to morbidity, mortality, and healthcare costs. We analyzed age-specific characteristics and factors associated with readmissions. Methods: Using the 2016–2021 National Readmissions Database, we identified adult AML hospitalizations for allo-HCT, stratified into <45, 45–65, and >65 years. Patient demographics, hospital factors, comorbidities, complications and outcomes were analyzed. Multivariable Cox regression determined adjusted hazard ratios for 30-day readmissions. Results: Of 15,757 admissions, 3,743 were <45, 8,169 were 45–65, and 3,844 were >65 years. The younger cohort had a higher proportion of females (53% vs. 47% vs. 39%, p<0.001). Overall infection rates, acute graft-versus-host disease, and use of total body irradiation were similar across groups (p>0.05). Mean LOS was 29 vs. 32 days for >65 and <45 years (p<0.001). Inpatient mortality was 4%, 5% and 6% in young, middle-aged and older group (p=0.02), while readmission rates (27% vs. 27% vs. 30%, p=0.16) and mortality during readmission (5% vs. 7% vs. 7%, p=0.42) were comparable. Mean time to readmission was 12 days, primarily driven by infections (34%), GI/hepatobiliary complications (10%), active AML (5%), & kidney dysfunction (5%). Lower-income quartiles vs. wealthiest and Medicare vs. private insurance were linked to higher readmission risk. Depression further elevated risk, whereas home-health care lowered it. Among clinical variables, GVHD, chronic kidney disease, and acute respiratory failure each predicted higher readmission (see Table). Conclusions: Our findings highlight disparities in 30-day readmissions after allo-HCT for AML, driven by socioeconomic, clinical, and mental health factors. Targeted interventions, such as optimizing post-discharge care and providing psychosocial support, may help reduce the readmission burden in high-risk patients. Factors associated with 30-day readmissions Adjusted Hazard Ratio 95% Confidence Interval p value Year of Admission (2021 vs. 2016) 0.71 0.53-0.95 0.02 Median household income Quartile 1 (poorest) Reference Quartile 2 0.84 0.74-0.96 0.011 Quartile 3 0.83 0.72-0.95 0.006 Quartile 4 (wealthiest) 0.74 0.65-0.85 <0.001 Private Insurance vs. Medicare 0.86 0.76-0.97 0.018 Large Metro Hospital vs. Others 1.25 1.03-1.52 0.023 Home-health care vs. Routine discharge 0.88 0.78-0.99 0.027 Acute Respiratory Failure 1.32 1.06-1.65 0.013 Fluid-electrolyte imbalance 1.11 1.01-1.22 0.034 Cardiac arrhythmia 1.17 1.02-1.33 0.021 Acute graft-versus-host disease 1.21 1.05-1.39 0.007 Chronic kidney disease 1.45 1.18-1.78 0.001 Depression 1.16 1.02-1.32 0.021 Length of Stay ≤30 days Reference 31-40 days 1.28 1.13-1.46 <0.001 >40 days 1.29 1.11-1.51 0.001