Effect of Hospital Teaching Status on Mortality and In-Hospital Outcomes in Patients Hospitalized With Acute Leukemia: A National Study

PURPOSE Acute leukemia is a complex hematologic malignancy characterized by the uncontrolled proliferation of developing leukocytes. Prior studies have considerably investigated the impact of medical training settings on the outcomes of hospitalized patients. Nevertheless, there remains a paucity of studies exploring the correlation between teaching hospital status and patient outcomes for those admitted with acute leukemia. METHOD We used the National Inpatient Sample (NIS) 2017-2020 to identify patients admitted with the primary diagnosis of acute leukemia (including acute myeloid and acute lymphoblastic leukemia. ) We stratified the patients into those admitted to teaching hospitals (TH) and nonteaching hospitals (NTH). The primary outcome studied was mortality between the two groups, and the secondary outcomes included length of stay, total cost of hospitalization, and adverse in-hospital outcomes. RESULTS A total of 108, 495 patients were hospitalized with acute leukemia, of which 9, 156 (8. 4%) were admitted to NTH and 99, 327 (91. 5%) were admitted to TH. The mean age of patients was 49. 26 ±25. 88, p<0. 001. Of the admitted patients, 17. 9% were <18 years old, and 82. 05% were ≥ 18. Males in TH and NTH were 55. 68% vs. 54. 34%, respectively, and females in TH and NTH were 44. 32% vs. 45. 66%, respectively, p<0. 001. After adjusting for confounding variables, no difference was noted in the odds of mortality between TH and NTH (OR=1. 12, 95% CI (0. 91-1. 36), p=0. 263). Those admitted in TH had prolonged length of stay (+7. 92 days, 95% CI (6. 77-9. 08), p<0. 001) and increased total cost of hospitalization (131, 854, 95% CI (105, 895-157, 813), p<0. 001). Patients in TH also had increased odds of acute kidney injury (OR=1. 20, 95% CI (1. 03-1. 39), p=0. 01), fluid and electrolyte disorders (OR= 1. 38, 95% CI (1. 21-1. 59), p<0. 001), sepsis (OR=1. 42, 95% CI (1. 15-1. 76), p=0. 001), ICU admission (OR=1. 28, 95% CI (1. 02-1. 61), p=0. 03), intubation (OR=1. 39, 95% CI (1. 09-1. 78), p=0. 007), vasopressor use (OR=1. 92, 95%CI (1. 13-3. 25), p=0. 015), febrile neutropenia (OR=1. 62, 95% CI (1. 37-1. 93), p<0. 001), and delirium (OR=2. 63, 95% CI (1. 35-5. 10), p=0. 004). CONCLUSION Our study shows that hospital teaching status is not considered an independent predictor of mortality in hospitalized patients with acute leukemia. However, patients admitted to TH had prolonged lengths of stay and total costs of hospitalization, along with other adverse hospital outcomes. Further prospective studies are needed to validate the findings of our research.