Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2023; 14(8): 311-323
Published online Aug 24, 2023. doi: 10.5306/wjco.v14.i8.311
Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission: A nationwide analysis
Philip Kanemo, Keffi Mubarak Musa, Vaishali Deenadayalan, Rafaella Litvin, Olubunmi Emmanuel Odeyemi, Abdultawab Shaka, Naveen Baskaran, Hafeez Shaka
Philip Kanemo, Department of Internal Medicine, Rapides Regional Medical Center, Alexandria, LA 71301, United States
Keffi Mubarak Musa, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria 88445, Kaduna, Nigeria
Vaishali Deenadayalan, Rafaella Litvin, Hafeez Shaka, Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60623, United States
Olubunmi Emmanuel Odeyemi, Department of Internal Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso 210101, Oyo, Nigeria
Abdultawab Shaka, Department of Medicine, Windsor University School of Medicine, St. Kitts, Frankfort, IL 60423, United States
Naveen Baskaran, Department of Medicine, University of Florida, Gainesville, FL 32610, United States
Author contributions: Kanemo P and Shaka H conceived of the presented idea and designed and proposed the study protocol; Deenadayalan V and Litvin R extracted data from the nationwide readmission database; Shaka A and Baskaran N provided tools for analysis and conducted the analysis; Musa KM, Shaka H and Odeyemi OE interpreted the analysis results and wrote the manuscript; Shaka H and Kanemo P supervised the findings of this work; all authors discussed the results and contributed to the final manuscript.
Institutional review board statement: As the nationwide readmission database data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study.
Informed consent statement: As the nationwide readmission database data is anonymous and cannot be used to identify patients, informed consent statement was not required for this study.
Conflict-of-interest statement: The authors hereby declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Keffi Mubarak Musa, MBBS, Doctor, Research Assistant, Department of Medicine, Ahmadu Bello University Teaching Hospital, Flat 8, street A, Transit Camp, Shika, Zaria 88445, Kaduna, Nigeria. keffimubarakmusa@gmail.com
Received: May 7, 2023
Peer-review started: May 7, 2023
First decision: July 4, 2023
Revised: July 12, 2023
Accepted: August 8, 2023
Article in press: August 8, 2023
Published online: August 24, 2023
Processing time: 106 Days and 5 Hours
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment.

AIM

To determine the effect of COVID-19 pandemic on cancer patients’ care.

METHODS

A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata® Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study.

RESULTS

A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, P < 0.05], paralysis (HR = 1.26, P < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, P = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, P < 0.01), paralysis (HR = 1.21, P = 0.02), and peripheral vascular disorders (HR = 1.15, P < 0.01).

CONCLUSION

The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Keywords: Chemotherapy; Coronavirus disease 2019 pandemic; Nationwide readmission database; Readmission rates; Cancer; Healthcare cost

Core Tip: Our nationwide study explored care for patients undergoing inpatient chemotherapy during the coronavirus disease 2019 (COVID-19) pandemic. It is the first to analyze factors surrounding hospitalization for such patients. We found a higher readmission rate during the pandemic, with comorbidities posing a greater risk. Surprisingly, COVID-19 infection was not significantly linked to readmission. Hospitalization costs rose, averaging 22952.00 dollars. Our findings would interest the scientific community, hospital managers, and health policymakers. Understanding the pandemic's impact on cancer patients' care can lead to mitigating health policies.