Back to Search
Start Over
Discharge Disposition Following Hematopoietic Cell Transplantation: Predicting the Need for Rehabilitation and Association with Survival
- Source :
- Transplant Cell Ther
- Publication Year :
- 2020
-
Abstract
- Many hematopoietic cell transplantation (HCT) recipients require rehabilitation due to deconditioning following intensive conditioning regimens and immune reconstitution. HCT recipients are preferentially discharged to home to avoid the risk of exposure to healthcare-associated infection in a rehabilitation facility (RF), with a caregiver who has been provided specific education about the complexity of post-HCT care. This study was conducted to determine the incidence of discharge to an RF following HCT, identify pre-HCT and peri-HCT risk factors for discharge to an RF, and estimate the effect of discharge disposition on overall survival (OS). This retrospective, matched 1:4 case-control study included 56 cases over a 10-year period from a single institution. Controls were matched by transplantation type (autologous versus allogeneic) and date of transplantation. The incidence of discharge to an RF was 2.2%. Controlling for disease, increasing age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04 to 1.15; P.001), female sex (OR, 3.11; 95% CI, 1.32 to 7.32; P = .01), high-risk HCT Comorbidity Index (HCT-CI) score (≥3) (OR, 3.44; 95% CI, 1.39 to 8.52; P = .008), decreasing pre-HCT serum albumin (OR, 2.60; 95% CI, 1.07 to 6.38; P = .037), and development of acute kidney injury during HCT (OR, 4.10; 95% CI, 1.36 to 12.40; P = .012) were associated with discharge to an RF. Discharge to an RF was associated with worse OS and higher nonrelapse mortality (NRM) compared with discharge to home (1-year OS, 70.5% [95% CI, 55.8% to 81.1%] versus 88.8% [95% CI, 83.6% to 92.4%], P.001; 100-day NRM: 9.5% [95% CI, 3.5% to 19.2%] versus 1.8% [95% CI, 0.6% to 4.3%]; P = .03). Discharge to an RF following HCT is a rare event but associated with poor OS. Modifiable risk factors for discharge to an RF, including serum albumin as a measure of nutrition and reversible HCT-CI components, should be prospectively studied to determine the effect of mitigation on discharge disposition and survival.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Disease
Article
Deconditioning
hemic and lymphatic diseases
Internal medicine
medicine
Immunology and Allergy
Humans
Transplantation, Homologous
Retrospective Studies
Transplantation
Rehabilitation
business.industry
Incidence (epidemiology)
Discharge disposition
Hematopoietic Stem Cell Transplantation
Cell Biology
Hematology
Odds ratio
Confidence interval
Patient Discharge
surgical procedures, operative
Case-Control Studies
Molecular Medicine
Female
business
Subjects
Details
- ISSN :
- 26666367
- Volume :
- 27
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Transplantation and cellular therapy
- Accession number :
- edsair.doi.dedup.....ed1141f3324c913a2fa7691c5dd9981d