Frequency and Reasons for Return to the Primary Acute Care Service Among Patients With Lymphoma Undergoing Inpatient Rehabilitation

Objective: To assess the frequency and risk factors for return to the primary acute careservice among patients with lymphoma undergoing inpatient rehabilitation. Design: Retrospective study. Setting: Tertiary referral-based cancer center. Patients: All patients with a history of lymphoma admitted to an inpatient rehabilitation between October 1, 2003, and January 30, 2013. Main Outcome Measures: Items analyzed from patient records included return to the primary acute care service with demographic information, lymphoma characteristics, medications, hospital admission characteristics, and laboratory values. Results: A total of 143 unique patient admissions were analyzed, and 54 of these 143 lymphoma inpatient rehabilitation admissions (38%) returned to the primary acute care service. However, 16 of 54 (30%) returned because they needed additional chemotherapy. Excluding patients who returned to the primary acute care service for chemotherapy, statistically significant or approaching statistically significant factors (P< .10) associated with return to the primary acute care service included a creatinine level≥1.3 mg/dL (P= .0002), male gender (P= .001), history of hematopoietic stem cell transplantation (P= .0355), and presence of an intravenous antifungal agent (P= .0717). Of the patients transferred back to the primary acute care service, 13 of 38 (34%) were discharged directly home, 10 of 38 (26%) died in the hospital, 7 of 38 (18%) were transferred to a subacute rehabilitation facility, and 4 of 38 (11%) were transferred to inpatient rehabilitation. Conclusions: When excluding patients who returned for chemotherapy, patients with lymphoma who were male, had undergone hematopoietic stem cell transplantation, and had a creatinine level≥1.3 mg/dL demonstrated increased risk for return to the primary acute care service.