Association between interhospital transfer and increased in-hospital mortality in patients with spinal epidural abscesses.

OBJECTIVE In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD. METHODS The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes. RESULTS Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18–1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16–1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46–1.98, p < 0.001), with no significant difference in inpatient mortality rates. CONCLUSIONS Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.

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Impact of Patient-Level Characteristics on In-hospital Mortality After Interhospital Transfer to Medicine Services: an Observational Study

Journal of General Internal Medicine ◽

10.1007/s11606-020-05659-8 ◽

2020 ◽

Vol 35 (4) ◽

pp. 1127-1134

Author(s):

Marc Heincelman ◽

Mulugeta Gebregziabher ◽

Elizabeth Kirkland ◽

Samuel O Schumann ◽

Andrew Schreiner ◽

...

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Patient Level ◽

Interhospital Transfer

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295 Interhospital Transfer is Not a Predictor of In-Hospital Mortality for Patients With Nontraumatic Intracranial Hemorrhage

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2017.07.273 ◽

2017 ◽

Vol 70 (4) ◽

pp. S116-S117

Author(s):

M.F. Yip ◽

J.E. Sather ◽

K.N. Sheth ◽

C.C. Matouk ◽

R. Littauer ◽

...

Keyword(s):

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Interhospital Transfer

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Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia

Critical Care and Resuscitation ◽

10.51893/2020.4.oa6 ◽

2020 ◽

Vol 22 (4) ◽

pp. 335-343

Author(s):

Paul Secombe ◽

◽

Alex Brown ◽

Michael Bailey ◽

Edward Litton ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Units ◽

Sampling Period ◽

Patient Characteristics ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Interhospital Transfer ◽

Patient Database

Objective: To describe the characteristics and outcomes of patients admitted to regional and rural intensive care units (ICUs). Design, setting and participants: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for admissions between January 2009 and June 2019. Characteristics and outcomes of patients admitted to regional and rural ICUs were compared with metropolitan and tertiary ICUs. Main outcome measures: Primary outcome was hospital mortality. Secondary outcomes included patient characteristics, ICU mortality, ICU and hospital length of stay, need for mechanical ventilation and need for interhospital transfer. Results: Over the sampling period, admissions to regional/rural ICUs averaged nearly 19 000 episodes per annum and comprised 20% of critical care admissions in Australia. Unadjusted mortality was lower, a result that persisted after adjustment for a range of confounders (odds ratio, 0.73; 95% CI, 0.67–0.80; P < 0.01). Admissions are more likely to be emergencies, and patients are more likely to live in areas of relative disadvantage and to require interhospital transfer, but are less likely to require mechanical ventilation. Conclusions: Although illness severity is lower for patients admitted to regional/rural ICUs, hospital mortality after adjustment for a range of confounders is lower. Compared with tertiary ICUs, emergency admissions are more likely, which may have implications for surge capacity during pandemic illness, while mechanical ventilation is less frequently required. Regional/rural ICUs provide care to a substantial proportion of critically ill patients and have a crucial role in the support of regional Australians.

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