The Impact of July Admission on Outcome in Patients with Hematopoietic and Lymphoid Malignancy Admitted with Tumor Lysis Syndrome

Introduction

The July phenomenon refers to the impact of the clinical inexperience of medical trainees transitioning to new patient care roles in July on patient outcomes. There have been conflicting data in prior studies as to the nature and severity of the outcome. Tumor lysis syndrome (TLS) is an uncommon complication of hematopoietic and lymphoid malignancy (HLM). TLS can quickly become life-threatening and requires timely diagnosis and urgent intervention. In this study, we explored the impact of the July phenomenon in patients with HLM admitted with TLS by comparing key outcomes between patients admitted in July and those admitted during the rest of the months of the year.

Method

We queried the Healthcare Cost and Utilization Project National Inpatient Sample and identified patients with HLM who were admitted with TLS from 2018-2021. We examined the differences in socio-demographic characteristics and all-cause mortality between patients admitted in July and those admitted during the rest of the months of the year. Secondary outcomes studied include acute kidney injury (AKI), the requirement for renal replacement therapy (RRT), acute respiratory failure (ARF), the requirement for mechanical ventilation (MV), ventricular arrhythmia (VTA), sudden cardiac death (SCD), disseminated intravascular coagulation (DIC), systemic inflammatory response syndrome (SIRS), new-onset seizure (NOS), gastrointestinal hemorrhage (GIH), non-traumatic intracerebral hemorrhage (NTICH), mean hospital length of stay and mean adjusted cost of hospitalization. Data was initially analyzed using a t-test, chi-square test, and univariate logistic regression. Multivariate logistic and linear regression models were used to compare outcomes between admission groups while adjusting for socio-demographic characteristics and comorbidities.

Results

A total of 25,335 adults with HLM who had a discharge diagnosis of TLS were identified (1.2 % Hodgkin lymphoma, 43.7 % non-Hodgkin's lymphoma, 10.8 % multiple myeloma, 22.5 % lymphoid leukemia and 27.1 % myeloid leukemia). Approximately 5.3% had a diagnosis of more than one HLM category. A total of 2,165 (8.5%) patients were admitted in July. There was a significantly lower proportion of females in the July admission group (29.1% vs 34.6%, p=0.02). There was no significant difference in other socio-demographic characteristics between the two groups. All-cause mortality was insignificantly higher in those admitted in July with an adjusted odds ratio (aOR) of 1.03 (95% CI 0.8-1.3). Secondary outcomes including ARF with aOR 1.02 (95% CI 0.82-1.27), MV with aOR 1.09 (95% CI 0.83-1.43), SCD with aOR 1.19 (95% CI 0.78-1.80), SIRS with aOR 1.05 (95% CI 0.83-1.32), GIH with aOR 1.41 (95% CI 0.93-2.14) and NTICH with aOR 1.10 (95% CI 0.39-3.09) were also insignificantly higher in the July admission group. Interestingly, AKI with aOR 0.99 (95% CI 0.80-1.22), RRT with aOR 0.85 (95% CI 0.62-1.16), VTA with aOR 0.34 (95% CI 0.08-1.40), DIC with aOR 0.79 (95% CI 0.53-1.19), NOS with aOR 0.30 (95% CI 0.04-2.30) were all insignificantly lower in the July admission group. Furthermore, the mean adjusted cost of hospitalization for the entire cohort was $217,626 and the mean hospital length of stay was 12.3 days with no significant difference between the groups.

Conclusion

The results of the study revealed that there was no statistically significant difference in all-cause mortality and other studied outcomes between the two groups. Further studies should investigate the July phenomenon by exploring other potential predictors, medical conditions, and outcomes.

No relevant conflicts of interest to declare.