Impact of hospital safety-net status on in-hospital and short-outcomes after hematopoietic stem cell transplantation

Safety-net hospitals (SNHs) cater to the medical needs of underserved populations, but their impact on the outcomes of hematopoietic stem cell transplantation (HSCT) remains unclear. The aim of this study was to evaluate the relationship between safety-net status and posttransplant outcomes using the National Readmission Database (NRD), including in-hospital mortality, in-hospital complications, and readmission. This was a retrospective cohort study. Adult patients who underwent allogeneic or autologous HSCT were identified using ICD-9 and ICD-10 procedure codes. Hospitals were classified as SNHs or non-SNHs based on the proportion of Medicaid patients they served. A total of 30,924 patients were treated in the SNHs group and 99,582 in the non-SNHs group. The incidence of in-hospital complications was higher in SNHs. Among those who underwent autologous HSCT (auto-HSCT), in-hospital mortality (2.7% vs. 2.3%; OR = 1.14, 95% CI: 1.02-1.27; P = 0.024) and 30-day readmission rates (16.3% vs. 15.2%; aOR = 1.05, 95% CI: 1.02-1.09; P < 0.001) were modestly higher in SNHs. Similarly, among patients undergoing allogeneic HSCT (allo-HSCT), those treated at SNHs had slightly higher in-hospital mortality (6.5% vs. 5.1%; OR = 1.24, 95% CI: 1.07-1.44; P < 0.001) and 30-day readmission rates (31.6% vs. 28.0%; aOR = 1.13, 95% CI: 1.05-1.23; P = 0.002). However, the magnitude of these differences was modest. These findings should be interpreted with caution given the observational design. While the results may suggest potential disparities in care, further studies are needed to clarify whether the observed differences are driven by patient-level or hospital-level factors and to determine whether targeted interventions may be beneficial.