Background/Objectives: Hematological toxicities (i.e., neutropenia, thrombocytopenia, and anemia), are common chemotherapy complications and may be exacerbated by renal or hepatic impairment due to altered drug exposure. This study assessed the association between renal and hepatic impairment and hematologic toxicities during chemotherapy in routine clinical practice. Methods: A single-center retrospective cohort study using the Utrecht Patient Oriented Database (UPOD) identified all chemotherapy administrations at the University Medical Centre Utrecht between 2011 and 2024. Regimens administered in ≥10 patients and ≥5 renally (GFR < 60 mL/min) or hepatically (bilirubin or AST > 1× ULN) impaired patients were included in descriptive analyses. Cox proportional hazards models estimated associations between organ impairment and grade ≥ 3 hematologic toxicities for regimens with ≥10 events per toxicity endpoint. Results: Overall, 4489 patients were included in renal analyses and 6218 in hepatic analyses, with smaller endpoint-specific subgroups for survival analyses. Renal impairment was associated with grade ≥ 3 neutropenia (HR: 1.43 [95% CI: 1.18–1.73]), thrombocytopenia (HR: 1.46 [95% CI: 1.15–1.86], and anemia (HR: 1.66 [1.27–2.16]). Hepatic impairment was similarly associated with neutropenia (HR: 1.25 [95% CI: 1.11–1.40]), thrombocytopenia (HR: 1.33 [95% CI: 1.13–1.57]), and anemia (HR: 1.62 [95% CI: 1.34–1.95]). Cyclophosphamide (pro-drug) regimens showed higher toxicity risk in renally impaired patients and reduced risk in hepatically impaired patients. Etoposide, melphalan and methotrexate were associated with increased toxicity in hepatically impaired patients. Conclusions: Renal and hepatic impairment significantly increase chemotherapy-induced hematologic toxicity. Several high-risk chemotherapy regimens were identified; however, larger multi-center datasets are needed to refine dosing guidance based on renal and hepatic function.

Background: Trauma care is inherently complex due to wide variability in patients, injury patterns, possible treatment strategies, and achievable outcomes that dynamically interact and influence the risk of complications and long-term functional recovery. Mortality-focused research insufficiently reflects this complexity and the evolving goals of trauma care. A Learning Healthcare System offers an opportunity to learn from routine clinical care by integrating data and translating findings into feedback. Objective: This paper proposes a comprehensive framework for continuous evaluation and improvement of trauma care that integrates patient and injury characteristics with care processes, complications, and outcomes beyond mortality, and describes an institutional data infrastructure that can support this framework. Approach: A conceptual framework based on routine care data is described, together with an institutional example combining the Dutch National Trauma Registry, the Utrecht Patient-Oriented Database, and a specialty complication registry. No new patient-level data were created or analyzed, and the effectiveness of the integrated infrastructure was not evaluated. Maintaining these databases requires dedicated professionals, data managers, structured documentation, multidisciplinary collaboration, and continuous quality control. Conclusions: Linking complementary registries provides a foundation for a Learning Healthcare System in complex trauma care. Combining established mortality and morbidity reviews with the opportunities offered by large, integrated databases may facilitate the implementation of a Learning Healthcare System in trauma care.