Prolonged Hospital Discharge Timing and Oral-Systemic Complications in Hematopoietic Stem Cell Transplant Recipients with Ulcerative Mucositis

Objectives Oral ulcerative mucositis (OUM) is a common and severe complication of hematopoietic cell transplantation (HCT), contributing to pain, nutritional compromise, and increased infection risk. Prolonged hospital length of stay (LOS), defined by discharge timing, often reflects complication severity while concurrently elevating nosocomial exposure. In this study, we sought to identify the associations between longer LOS and systemic outcomes including infectious complications. Materials and 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 vs. 20–29 days; allogeneic HCT, 15–24 vs. 25–34 days. 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. Clinical Relevance: Discharge-based stratification highlights high-risk periods amenable to targeted supportive interventions to mitigate complications and facilitate earlier safe discharge.