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Background. OM is a common toxicity of conditioning regimens for HSCT that has been associated with adverse clinical and economic outcomes. Methods. A retrospective chart review study of ~400 consecutive HSCT recipients with hematologic malignancies was undertaken at a single academic center. OM severity was assessed across eight oropharyngeal sites using a validated scale which was scored as follows: no erythema/ulceration = 0; erythema only = I; ulceration one site = II; two sites = III; three sites= IV; and four or more sites = V. OM assessments began on the day of conditioning and continued bi-weekly until hospital discharge. Outcomes of interest included number of days of fever, total parenteral nutrition (TPN), and parenteral narcotic therapy, incidence of Grade III or IV (Common Toxicity Criteria) infection, and inpatient days and charges. We report data here for the 281 AL HSCT recipients in the study cohort. Results. Mean age was 41 yrs. Most common diagnoses were acute (33%) and chronic (19%) myeloid leukemia. Most patients (96%) received total body irradiation. Fifty-one percent of grafts were from unrelated donors. Seventy-six percent of patients experienced OM ≥ grade II. The relationship between worst recorded grade of OM and each of the outcomes of interest is reported below. Conclusions. OM is associated with worse clinical and economic outcomes in patients with hematologic malignancies undergoing AL HSCT. Outcomes of AL HSCT in patients with hematologic malignancies, by worst recorded grade of OM Worst Grade of OM (N=281) 0 I II III IV V Outcome n=34 n=33 n=70 n=60 n=43 n=41 -value p *mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures Fever days* 3.1 (3.0) 4.8 (4.4) 5.3 (4.9) 5.7 (4.7) 5.9 (4.7) 7.3 (4.6)

Background. OM is a common toxicity of conditioning regimens for HSCT that has been associated with adverse clinical and economic outcomes. Methods. A retrospective chart review study of ~400 consecutive HSCT recipients was undertaken at a single academic center. OM severity was assessed across eight oropharyngeal sites using a validated scale which was scored as follows: no erythema/ulceration = 0; erythema only = I; ulceration one site = II; two sites = III; three sites= IV; and four or more sites = V. OM assessments began on the day of conditioning and continued bi-weekly until hospital discharge. Outcomes of interest included number of days of fever, total parenteral nutrition (TPN), and parenteral narcotic therapy, incidence of grade III or IV (Common Toxicity Criteria) infection, and inpatient days and charges. We report data here for the 115 MM patients in the study cohort who underwent AU HSCT after high-dose MP conditioning. Results. Mean age was 54 yrs. Seventeen percent of patients received total body irradiation. Bone marrow was the source of most grafts. Forty-eight percent of patients experienced OM ≥ grade II. The relationship between worst recorded grade of OM and each of the outcomes of interest is reported below. Conclusions. OM is associated with worse clinical and economic outcomes in MM patients undergoing AU HSCT following high-dose MP conditioning. Outcomes of AU HSCT following high-dose MP conditioning for MM, by worst recorded grade of OM Worst Grade of OM (N=115) 0 I II III IV V *mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures Outcome n=37 n=23 n=24 n=15 n=8 n=8 -value p Fever days* 1.2 (2.8) 2.5 (3.1) 2.1 (2.3) 1.9 (1.4) 3.0 (2.1) 3.6 (6.2) 0.057 TPN days* 0.0 (0.0) 0.1 (0.4) 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) 2.3 (6.0) 0.003 Narcotic days* 1.5 (3.1) 4.7 (3.8) 4.6 (4.4) 4.4 (3.7) 7.9 (3.3) 9.9 (7.4)

Rationale . The risk of major bleeding in major orthopedic surgery (MOS) patients who receive antithrombotics as prophylaxis against venous thromboembolism (VTE) may be higher for some agents than others. The cost of this complication is unknown. Objective . To assess the impact of major bleeding following MOS on length of stay (LOS) and inpatient charges. Methods . Using a database with information on ~750,000 admissions annually to 100+ US acute-care hospitals (MQProfile, Cardinal Information Corp.), we identified all patients who underwent MOS between 1/1/98 and 12/13/00. We stratified patients according to whether or not they experienced major postoperative bleeding prior to hospital discharge, defined as: (a) fatal bleeding; (b) nonfatal bleeding at critical site; (c) re-operation due to bleeding; and (d) overt bleeding with bleeding index (BI) ≥ 2, where BI = number of blood units transfused plus pre-bleeding minus post-bleeding hemoglobin (g/dL) values. LOS and total inpatient charges were compared between patients with and without major bleeding. Results . 23,518 patients were identified who underwent MOS. Incidence of major bleeding was 2.6%. In multivariate analyses controlling for differences in baseline characteristics between patients with and without major bleeds, adjusted mean LOS was 1.8 days longer (95% CI: 1.5, 2.0) among the former (6.1 days vs 4.3 days for those without bleeds); adjusted mean total inpatient charges were $7,593 higher (95% CI: $6,622, $8,646) ($25,669 vs $18,076). Conclusion . Major bleeding following MOS significantly increases LOS and hospital charges. The cost of major bleeding following MOS should factor into choice of VTE prophylaxis.