Original article
Inpatient Cancer Rehabilitation: A Retrospective Comparison of Transfer Back to Acute Care Between Patients With Neoplasm and Other Rehabilitation Patients

Presented to the American Academy of Physical Medicine and Rehabilitation, November 2006, Honolulu, HI.
https://doi.org/10.1016/j.apmr.2008.01.014Get rights and content

Abstract

Alam E, Wilson RD, Vargo MM. Inpatient cancer rehabilitation: a retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients.

Objective

To determine whether patients with diagnoses of neoplasm undergoing acute rehabilitation differ from other patients in frequency of acute care transfer and type of medical complications.

Design

Retrospective cohort analysis.

Setting

Acute rehabilitation hospital located within an academic medical center.

Participants

Patients with diagnosis of neoplasm (n=40) and patients without neoplasm (n=253) requiring transfer were identified from a database of 2801 rehabilitation discharges over nearly a 4-year period.

Interventions

Not applicable.

Main Outcome Measures

Frequency of unplanned transfer and reasons for the transfer.

Results

Significant difference occurred in overall rate of transfer between patients with neoplasm (21%) and controls (9.7%; P<.001). When evaluated separately for type of neoplasm (with patients receiving corresponding type of rehabilitation as controls), a significantly higher rate of transfer to acute care was found for brain tumor (25% vs 12%; P=.004) and spinal cord neoplasms (23% vs 10%; P=.009), but statistical significance was not reached for other tumor types (12.5% vs 7.4%; P=.19). Patients with stroke with neoplasm as a comorbidity, analyzed separately, with the other patients with stroke as controls, had significantly higher risk of transfer (22% vs 10%; P=.012). Logistic regression analysis found an odds ratio (OR) of 2.5 for unplanned transfer among patients with diagnosis of neoplasm (OR=2.5 for malignancy; OR=2.4 for benign neoplasm). Patients with neoplasm had infection as the most common reason for transfer (28% of the neoplasm transfers vs 18% of other transfers; P=.01), whereas in the nonneoplasm group, cardiopulmonary factors predominated (12% of patients with tumor vs 31% of patients without tumor transfers; P<.001).

Conclusions

In the present sample, patients with neoplasm were more likely to require transfer than patients without neoplasm, although this pattern did not reach statistical significance for noncentral nervous system cases. Overall, patients with neoplasm appear more likely than those without neoplasm to have an infectious cause for unplanned transfer. Increased awareness of this difference may lead to improved medical management on rehabilitation units.

Section snippets

Data

The dataset consists of first-time, acute rehabilitation discharges at a large, academic rehabilitation facility from 2001 to 2005. Information was obtained from an institutional database that included impairment group, ICD-9 codes, age, sex, race, comorbid conditions, rehabilitation type (derived from the case-mix group number), tier status, admission FIM motor and cognitive scores, and discharge destination. The first author (EA) conducted chart reviews to determine the reason for transfer

Results

There were 3160 discharges during the study period, of which 359 were removed because they were not the initial rehabilitation stay. The final dataset included 2801 first-time discharges (table 1). The malignant neoplasm group was older than controls and also older than patients with neoplasm with benign tumors; no other major demographic differences were found. The prevalence of heart disease was significantly higher in the malignant cases, as was bladder infection in all neoplasm cases. Tier

Discussion

The main aim of this study was to compare the rate of transfer from acute rehabilitation between patients with and without neoplasm, which we found to be approximately 21% and 10%, respectively. The adjusted analysis found patients with neoplasm had about 2.5 times the odds of unplanned transfer to acute medical-surgical floors compared with controls, whether the neoplasm was malignant (OR=2.5) or benign (OR=2.4). Although primary analysis showed that patients with malignant neoplasm were

Conclusions

Rehabilitation patients with neoplasm are more likely to require transfer than patients without neoplasm, with the exception of non-CNS cases. Patients with neoplasm appear more susceptible to infection as the reason for transfer, whereas cardiopulmonary reasons predominate among patients without neoplasm. Development of care strategies that more aggressively prevent and/or treat infection may be warranted. Further study is needed to determine whether these results can be generalized to other

Acknowledgments

We thank John Chae, MD, for his assistance in the development of this project and statistical guidance, and Theresa Fitzgerald, OTR, for assistance with the database.

References (20)

There are more references available in the full text version of this article.

Cited by (53)

  • Cancer rehabilitation continuum of care and delivery models

    2018, Central Nervous System Cancer Rehabilitation
View all citing articles on Scopus

Supported by the National Institutes of Health (grant no. K12- HD01097).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

View full text