Assistant Professor The University of Texas MD Anderson Cancer Center Houston, Texas, United States
Objectives: Cancer patients may require acute care management that is typically not performed in conventional acute inpatient rehabilitation programs. The purpose of this study was to describe the frequency and types of medical complications and interventions in cancer patients undergoing acute inpatient rehabilitation. We also analyzed factors predictive for return to acute care services in this heterogeneous mix of neoplasm patients.
Design: We reviewed the records of all consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017 through February 28, 2018. Presenting problem noted to be a significant change in medical status using the Centers for Medicare & Medicaid Services’ (CMS) Evaluation and Management Service Guide was defined as a medical complication. We recorded demographic and clinical characteristics, medical complications and related interventions, and the discharge or transfer destinations. Multivariable logistic regression analysis were performed to assess factors predicting for returning to acute care services.
Results: Among 165 evaluable patients, 158 (96%) had at least one medical complication, and 31 (19%) had an unplanned return to acute care. The most common medical complications categories were electrolyte abnormalities 81 (50%), musculoskeletal 70 (43%), genitourinary/renal 61 (38%), hematologic 58 (36%), and cardiovascular problems 46 (28%). The interventions included medication management 151 (93%), laboratory tests 106 (65%), diagnostic tests 101 (62%), consultations 124 (77%), and procedures 32 (20%). Multivariable analysis showed that tachycardia (OR=7.83, 95% CI (2.23, 27.54), p=0.001) and weekly or more frequent red blood cell transfusions (OR=5.23, 95% CI (1.39, 19.64), p=0.014) were independently associated with unplanned return to acute care.
Conclusions: A high frequency and wide range of medical complications and interventions occur in cancer patients undergoing acute inpatient rehabilitation. Close monitoring and expertise are needed for this patient population.