Evidence-Based Criteria Supporting Early Discharge for Pediatric Patients With Osteosarcoma Receiving High-Dose Methotrexate: A Retrospective Chart Review

PURPOSE: The purpose of this study is to describe the outcomes following the implementation of an early discharge protocol for pediatric patients with osteosarcoma receiving high-dose methotrexate (MTX) to determine if the protocol safely decreased length of stay without increased toxicity. METHODS: This was a retrospective descriptive cohort design. Participants included children, 5 to 25 years of age, diagnosed with osteosarcoma, who received methotrexate between December 2017 and July 2019. A total of 141 doses across fifteen individual patients were included in the cohort. Data were abstracted from the electronic health record and analyzed using descriptive statistics. RESULTS: The majority of administrations (n = 94, 67%) met early discharge criteria without an increase in toxicity or hospital readmission. CONCLUSION: Pediatric patients receiving high-dose MTX for osteosarcoma can be safely discharged from the hospital when serum MTX level < 0.4 μmol/L with the implementation of education, hydration goals, frequent lab monitoring, and close follow-up. More than half of patients on this study were able to be discharged from the hospital sooner than prior protocol. More importantly, this retrospective chart review highlighted the ability to maintain safe administration without increasing toxicity.