Stratified discharge timing within mucositis cases and its association with systemic complications in hematopoietic stem cell transplant recipients: insights from a national inpatient study

BACKGROUND: Oral ulcerative mucositis (OUM) is a frequent and severe complication of hematopoietic cell transplantation (HCT). Whether prolonged hospital discharge timing, used as a proxy for extended length of stay (LOS), identifies greater systemic morbidity among patients who develop OUM remains unclear. This retrospective cohort study aimed to evaluate, among HCT recipients with documented OUM, whether prolonged discharge timing is independently associated with increased systemic complications. METHODS: This retrospective cohort study utilized the National Inpatient Sample to identify adult patients with leukemia or multiple myeloma undergoing autologous or allogeneic HCT complicated by OUM. Patients were stratified by discharge timing: autologous HCT, 10-19 (control) vs. 20-29 days; allogeneic HCT, 15-24 (control) vs. 25-34 days. Further, no control group of patients undergoing HCT without OUM was examined. Baseline characteristics and systemic outcomes-including healthcare-associated complications incorporating septicemias, isolated septicemia, coagulopathies, hypertension, and congestive heart failure-were compared. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aOR) for outcomes in prolonged versus shorter discharge strata, adjusting for demographics and comorbidity burden. RESULTS: Among autologous HCT recipients with OUM (weighted n = 1290), 21.7% experienced prolonged discharge. This stratum had significantly higher adjusted rates of healthcare-associated complications, including septicemias (aOR 3.09, 95% CI: 1.45-6.59), isolated septicemia (aOR 4.68, 95% CI: 1.83-11.96), and congestive heart failure (aOR 1.68, 95% CI: 2.44-11.58). Among allogeneic HCT recipients (weighted n = 885), 54.2% had prolonged discharge, associated with increased healthcare-associated complications including septicemias (aOR 3.3, 95% CI: 1.19-9.12), coagulopathies (aOR 3.47 with 95% CI: 1.33-9.03), and hypertension (aOR 2.00 with 95%CI: 1.05-3.82). No adverse outcomes occurred in discharges within 0-10 days. CONCLUSIONS: Prolonged discharge timing in HCT patients with OUM is independently associated with substantial systemic morbidity, including septicemia-related complications. Discharge-based stratification highlights high-risk periods amenable to targeted supportive interventions to mitigate complications and facilitate earlier safe discharge.