Interhospital Transfer of Intracranial Tumor Patients Have Higher Complexity Scores than Non-transfer Patients But Do Not Experience Worse Outcomes After Tumor Resection at a Tertiary Medical Center. (16th November 2020)

• Record Type: Journal Article
• Authors: Azizkhanian, Ida; Matluck, Nicole; Ogulnick, Jonathan; Dore, Silvi; Gatzoflias, Stergios; Hossain, Raeesa H; Schmidt, Meic H; Cole, Chad D; Bowers, Christian A; Tung, Brian
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_126
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Interhospital transfer (IHT) contributes to increasing health care costs and typically accounts for increased patient morbidity and mortality compared to non-IHT patients. IHT inefficiencies leave patients vulnerable to delayed care and subsequent poor outcomes. METHODS: We performed a single center retrospective review comparing IHT and non-IHT patients undergoing ITR from 2016–2018. Study variables included age, sex, race, surgical complexity Milan Score, modified Frailty Index (mFI), length of stay (LOS) and Clavien-Dindo Score. Chi-square and Mann-Whitney U tests were used to identify significant differences in these variables between groups, while variables predictive of transfer status were isolated with binary logistic regression. RESULTS: Data were collected from 265 patients undergoing ITR, with 84 (31.7%) IHT patients overall. The average age was 54 (SD 14) and 49.4% men. IHT patients had a longer LOS (19.3d v 15.8d, P = . 035). The Milan Score and mFI were also significantly higher in the IHT group ( P = . 002, P = . 033, respectively). However, when excluding pediatric patients, mFI ceased to be significantly different between groups ( P = . 57). Milan Score was predictive of IHT status in regression analysis (OR 1.2, P = . 007). CONCLUSION: Transfer patients for intracranial tumor resection have higher Milan Complexity Scores and thus comprise a more surgically challenging population compared to non-transfer patients. As expected, IHT patients have longer LOS as they live further from hospital by definition. Importantly, there were no significant difference in frailty, race, sex, or post-surgical complication between the two groups. Performing more complicated cranial surgeries, without increased complication rates, fulfills the mission of academic tertiary neurosurgical centers, where the increased volume of complex cases does not lead to worse outcomes with more complex cases.