Background: Febrile neutropenia (FN) being a life-threatening complication of chemotherapeutic drugs, demands extraordinary and distinct care than non neutropenic and septic patients. We used the National Inpatient Sample (NIS) database to analyze the regional disparities in the outcomes of hospitalized FN patients. Methods: Using NIS 2016-19 datasets, we identified chemotherapy related FN hospitalizations (ICD-10-CM codes) and analyzed (weighted) for differences in demographics, admitting hospital characteristics, primary (all-cause in-hospital mortality [ACM]) and secondary (severe sepsis with or without shock, need for packed red blood cells or platelet (RBC/PC) transfusion, length of stay [LOS], hospitalization cost and risk for 30-day readmission) outcomes among regions of hospitalization Northeast (NE), Midwest (MW), West (W), South (S). Results: Of 170525 FN hospitalized patients, S had the highest number (37.4%) followed by MW 24.1%, W 20.2%, NE 18.3%. Demographic characteristics showed significant differences for age distribution (eldest mean age for MW 62.4), race (highest whites in MW, black in S, Hispanic, API and NA in W), lowest quartile median household income in South. Mean Elixhauser comorbidity index was significantly different with highest in MW. All-cause mortality (5.8%; p<0.007), severe sepsis with (6.8%; p<0.001) and without shock (4.3%; p<0.001) were highest in W with significant differences among regions. Multivariate analysis revealed adjusted odds ratio (AOR) of 1.38 (p <0.001) for ACM in W than MW, severe sepsis with and without shock AOR being 1.7 and 1.36 in W than NE. Hospitalization cost (adjusted per US labor statistics hospital expenditure) was highest in W, with an incidence rate ratio 1.68 (p<0.001) in W than MW. Need for RBC/PC transfusion, LOS and risk of 30 day readmission did not differ significantly among the regions. Conclusion: Hospitalizations for chemotherapy-related FN had the highest all-cause in-hospital mortality along with severe sepsis (with/without septic shock) and hospitalization cost in the West region. These differences signify the disparities in the management of these patients in recent years. We suggest further studies to identify the patients who are at higher risk of poor outcomes with febrile neutropenia. Adopting uniform care guidelines and having quality metrics in place may help to minimize these regional variations and achieve uniform national outcomes.
Baseline characteristics and outcomes in chemotherapy-related febrile neutropenia patients stratified by region of hospitalization.
