OBJECTIVES: AML in the elderly is characterized by high short-term mortality and economic burden, with hospitalizations as the main driver. We examined clinical and economic outcomes of the initial hospitalization in an elderly cohort with newly-diagnosed AML. METHODS: An analysis of the 2002 Premier Perspective inpatient database was performed in patients >65 years with a new diagnosis of AML. RESULTS: A total of 509 (46% female) patients accounting for 803 hospital admissions, met the inclusion criteria. There was an equal proportion of patients in the groups aged 65-74 and > 75. Of the 183 (36%) patients receiving chemotherapy (CT) on first admission, 41% received standard induction (SI), 31% non-SI and 27% hydroxyurea (H). Among CT group, more SI patients were younger than non-SI patients (73% and 51% 65-74 yrs, respectively), while fewer non-CT and H patients were younger (39% and 32%, 65-75 yrs, respectively). CT patients were less likely to have comorbidities (8%) compared to non-CT (17%). Sixty-three percent of all hospital deaths occurred during the first hospitalization with the majority occurring within the first two weeks. Overall hospital death rate during the first hospitalization was 29%, but higher in SI (39%) and non-SI (40%). Longer hospital stay in SI and non-SI patients, 30 and 21 days, respectively, was also observed, compared to 12 days overall . Mean (SD) costs of first hospitalization was $36,866($33,045) and $8,936($10,340) for CT and non-CT, respectively but comparable on a per day basis. CONCLUSIONS: AML remains devastating and costly. Hospital mortality is high during the initial hospitalization, and a substantial proportion of deaths in this period occurs within the first two weeks.