Effect of Bone Marrow Transplant on Emergency and Inpatient Readmission Rates Among Children with Sickle Cell Disease in Saudi Arabia: A Multi-Episode Survival Analysis

Background: Hospital readmissions among pediatric sickle cell disease (SCD) patients significantly strain healthcare systems. In Saudi Arabia, limited research has ex-plored the role of bone marrow transplant in reducing recurrent emergency and inpatient readmissions among children with SCD. This study investigates the impact of bone mar-row treatment on post-discharge readmission rates using a multi-episode survival framework. Methods: We conducted a retrospective cohort study using electronic health records from 2015 to 2023 of children aged ≤11 years diagnosed with SCD across multiple hospitals in Saudi Arabia. A multi-episode survival analysis based on the Andersen-Gill model was employed to evaluate the effect of bone marrow transplant on readmission rates up to 30, 90, 180, and 365 days following the first emergency or inpatient discharge. Patients were categorized into treatment (received bone marrow) and control groups, ad-justing for demographic, clinical, and healthcare system-related covariates. Results: The study included 234 patients. Bone marrow transplant significantly reduced the hazard of emergency readmissions within 365 days (HR=0.16; 95% CI: 0.06–0.44), while increasing the hazard of inpatient readmissions (HR=5.56; 95% CI: 3.03–11.11), possibly due to short-term immunosuppression post-transplant. Additional risk factors for higher read-mission rates included greater prior-year emergency visits, SCD related complications, and healthcare facility type. Conclusions: Bone marrow transplant appears effective in reducing emergency readmissions in pediatric SCD patients, though it may increase short-term inpatient admissions. Findings underscore the importance of targeted post-transplant care and inform healthcare policy on effective interventions for reducing readmission burdens in Saudi Arabia.