462 Is Transfer Status Associated With Inpatient Mortality in Patients Transferred for Non-Elective Neurosurgical Diagnoses?. (1st April 2022)

• Record Type: Journal Article
• Authors: Khan, Imad S.; Pomponio, Maria; Hong, Jennifer
• Is Part Of: Neurosurgery. Volume 68(2022)Supplement 1
• Page Start: 112
• Page End: 113
• Publication Date: 2022-04-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001880_462
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Inter-hospital transfer plays an important role in providing patients appropriate care in a timely fashion. There is a concern, however, that patients who are transferred fare worse than those who are not. While some work has been done looking at specific diagnoses, a more general overview of the impact of transfer status on neurosurgical patient outcomes is lacking. METHODS: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2009 to 2018 to determine if the likelihood of mortality was associated with being transferred with non-elective neurosurgical diagnoses. We used multivariate regression analysis with the transfer status as our main exposure and inpatient mortality as the primary outcome. Our model controlled for patient demographics, hospital characteristics, and severity of illness. RESULTS: Out of a total of 2, 080, 460 patient weighted discharges with neurosurgical diagnoses, 387, 321 (18.7%) were transferred. After controlling for patient- and hospital-related confounders, patients transferred for ventricular shunt procedure had a higher likelihood of inpatient mortality - OR 1.55, 95% CI 1.23, 2.14, p = 0.001. However, intracranial vascular disease (OR 0.72, 95% CI 0.64, 0.82, p < 0.001), craniotomy with device diagnoses (OR 0.87, 95% CI 0.81, 0.92, p < 0.001), craniotomy and intravascular procedures (OR 0.77, 95% CI 0.70, 0.84, p < 0.001), and trauma (OR 0.80, 95% CI 0.75, 0.89, p < 0.001), were all associated with a statistically significantly lower odds of inpatient mortality. The diagnosis of peripheral and cranial nerve disorders was not associated with inpatient mortality (OR 1.07, 95% CI 0.88, 1.30, p = 0.05). CONCLUSION: For most non-elective neurosurgical diagnoses, patients who are transferred have no difference or a lower likelihood of inpatient mortality. However, patients transferred for ventricular shunt procedures have significantly higher odds of inpatient mortality. Further work in understanding how the transfer status affects outcomes may help identify areas for improvement.