Abstract
The impact of COVID-19 on national trends of hospitalization and outcomes for acute leukemias.
Author
Prarthna V. Bhardwaj
University of Massachusetts Chan Medical School - Baystate, Springfield, MA
info_outline
Prarthna V. Bhardwaj, Sneha Nagesh Rao, Deepak Pasupula, Kathan Mehta, Sudeep Kumar Siddappa Malleshappa
Full text
Authors
Prarthna V. Bhardwaj
University of Massachusetts Chan Medical School - Baystate, Springfield, MA
info_outline
Prarthna V. Bhardwaj, Sneha Nagesh Rao, Deepak Pasupula, Kathan Mehta, Sudeep Kumar Siddappa Malleshappa
Organizations
University of Massachusetts Chan Medical School - Baystate, Springfield, MA, Albany Medical Center, Albany, NY, MercyOne North Iowa Medical Center, Mason City, IA, Independent Physician Researcher, Ocean Springs, MS
Abstract Disclosures
Research Funding
No funding received
None.
Background:
Acute leukemias are traditionally managed in a hospital setting. During the initial phase of the COVID-19 pandemic, there was a gross shortage of hospital resources and rationing of care. We aimed to study the differences in national trends of hospitalizations and outcomes for acute leukemias in 2019 (pre-pandemic) and 2020 across the United States.
Methods:
We performed a retrospective study utilizing the National Inpatient Sample (NIS) of adults hospitalized for management of acute leukemias as the primary diagnosis using ICD-10-CM codes. We excluded all patients with a prior or current hospitalization for stem cell transplantation. We compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. Outcomes included mortality, length of stay (LOS) and cost of hospitalization. We compared mortality among patients with and without COVID in 2020 using chi-square analysis.
Results:
Of 166795 admissions for acute leukemia, 71.8% were acute myeloid leukemia (AML), 25.2% were acute lymphoblastic leukemia (ALL) and 3.1% were acute promyelocytic leukemia (APML). Overall, patients were predominantly male (55%), White (68%) presenting to large hospitals (67%) specifically urban teaching hospitals (88%). When compared between 2019 and 2020, there was no difference in the proportion not receiving chemotherapy for their leukemia (77.7% vs 78.6% in 2019 and 2020 respectively). There were no differences between mortality (8.6% vs 8.7%) or median LOS (6 days vs 5 days). The total cost of hospitalization was higher in 2020 ($155,961) compared to 2019 ($151,372). When stratified by COVID-19 infection in 2020, mortality was higher among COVID infected patients in AML (27.5% vs 10.08%, p=0.000), in ALL (16.87% vs 3.30%, p=0.000) as well as APML (26.32% vs 11.5%, p=0.139).
Conclusions:
Overall, there were no differences in the hospitalizations, rates of chemotherapy administration, mortality or LOS for acute leukemia pre and post COVID-19. However, in 2020, patients with AML and ALL with a concurrent COVID-19 diagnosis had a higher mortality.
Mortality stratified by concurrent COVID-19 diagnosis in 2020.
Mortality (Yes)
COVID
P-value
No
Yes
AML
5720 (10.08%)
275 (27.50%)
0.000
ALL
665 (3.30%)
70 (16.87%)
0.000
APML
280 (11.5%)
25 (26.32%)
0.139
4 organizations
3 drugs
2 targets
Organization
Albany Medical CenterOrganization
MercyOne North Iowa Medical CenterOrganization
Independent Physician Researcher