e16409 Background: Febrile neutropenia (FN) is a potentially life-threatening complication of myelosuppressive chemotherapy and a common cause of hospitalization among patients with pancreatic cancer. Despite the widespread use of intensive cytotoxic regimens in this population, contemporary data describing the national burden of FN, its demographic and health-system distribution, and associated inpatient outcomes are limited. Methods: We analyzed adult pancreatic cancer hospitalizations in the Nationwide Inpatient Sample from 2016-2022 using ICD-10-CM codes in any discharge diagnosis position. Febrile neutropenia (FN) was ascertained using validated diagnostic codes. Survey-weighted analyses were used to compare baseline characteristics and outcomes between hospitalizations with and without FN, and survey-weighted multivariable logistic regression was performed to evaluate the association between FN and in-hospital mortality after adjustment for demographics, hospital characteristics, and Elixhauser comorbidity burden. Results: Among an estimated 742,745 pancreatic cancer–related hospitalizations in the United States, 13,820 (1.9%) were complicated by FN. Patients with FN were slightly younger than those without FN (mean age 66.7 vs 68.4 years, P < 0.001), with a modest shift toward the 45–64-year age group. FN-associated hospitalizations occurred more frequently among White patients (75.2% vs 70.8%, P < 0.001). Although Medicare was the predominant payer in both groups, FN-associated hospitalizations had a higher proportion of privately insured patients (31.4% vs 26.2%, P < 0.001). From a health-system perspective, FN admissions were less frequently managed at urban teaching hospitals (74.6% vs 79.4%) and more often occurred in urban non-teaching and rural hospitals (P < 0.001). Overall comorbidity burden was slightly higher among FN admissions (Elixhauser score 5.46 vs 5.32, P = 0.015). After multivariable adjustment for demographics, hospital characteristics, and comorbidity burden, FN was independently associated with increased in-hospital mortality (aOR 1.63, 95% CI 1.35–1.98). Conclusions: In a nationally representative cohort, febrile neutropenia complicates approximately 1 in 50 hospitalizations among patients with pancreatic cancer and is concentrated in younger patients and tertiary-care centers. The persistence of increased mortality after adjustment for comorbidity burden underscores FN as an independent marker of vulnerability in pancreatic cancer, rather than merely a surrogate of baseline illness severity. These findings emphasize the importance of proactive risk stratification, appropriate use of growth-factor prophylaxis, early sepsis recognition, and system-level supportive-care pathways to mitigate the substantial mortality burden associated with FN in this high-risk oncologic population.
Regalla et al. (Thu,) studied this question.