Impact of prolonged hospitalization on outcomes in acute leukemia: A national inpatient sample analysis

Abstract Background: Acute leukemia (AL), which includes both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), often requires extensive inpatient treatment. Long hospital stays may indicate how severe the condition is, how difficult it is to treat, or how poor the healthcare system is. Nonetheless, there is a dearth of national data on the relationship between extended hospitalization and in-hospital outcomes in AL patients. Objective: To assess the impact of prolonged hospitalization on mortality, complications, and healthcare resource utilization among patients admitted with acute leukemia in the United States. Methods: We conducted a retrospective cohort study utilizing the National Inpatient Sample (NIS) from 2019 to 2021. We selected adult patients (≥18 years) with a primary diagnosis of AML or ALL using ICD-10-CM codes. Prolonged hospitalization was defined as a length of stay (LOS) exceeding 14 days (upper quartile criterion). Multivariable logistic regression was used to assess the correlations between longer LOS and in-hospital mortality, sepsis, ICU admission, and discharge disposition, after controlling for age, gender, race, insurance, comorbidities (Elixhauser Index), and hospital factors. Survey weights were used to obtain national estimates. Results: Among 47,283 weighted hospitalizations for acute leukemia, 24.3% (n=11,472) required protracted hospitalization. Patients with longer stays had higher in-hospital mortality (10.2% vs. 6.1%; adjusted odds ratio [aOR] 1.79, 95% confidence interval [CI] 1.61-1.98, p<0.001), higher incidence of sepsis (31.5% vs. 14.8%; aOR 2.52, 95% CI 2.35-2.70, p<0.001), and were more likely to require ICU admission (18.6% vs. 9.2%; aOR 2.14, 95% CI 1.95-2.35, p<0.001). Furthermore, they had higher rates of non-home release (37.1% vs. 20.5%; aOR 2.09, 95% CI 1.95-2.23, p<0.001) and spent significantly more on hospitalization ($112,400 vs. $68,900; p<0.001). Conclusions: Prolonged hospitalization in people with acute leukemia is independently associated with worse clinical outcomes and higher healthcare costs. Early identification of at risk for lengthy stays may allow for targeted efforts to decrease difficulties and improve care delivery. These results the need for hospital-based strategies to better manage high-risk leukemia admissions.