The Top 25 Comorbidities Reported During Inpatient Stays for Pediatric Hematopoietic Stem Cell Transplant: Patient Demographics and Impact on Inpatient Mortality and Charges

Abstract

OBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.