Abstract
Introduction: Prompt management of aneurysmal subarachnoid hemorrhage (SAH) is critical. Literature is inconclusive regarding outcomes for patients directly admitted to specialized centers versus transferred from lower-volume hospitals. Providers are often unclear about the safety of transferring critical patients. This study evaluated the "transfer effect" in a large sample of aneurysmal SAH patients undergoing treatment. Methods: Using Nationwide Inpatient Sample 2002-2007 data, we analyzed outcomes of SAH patients treated with coil or clip procedures. Analyses studied the effect of direct-admit versus transfer admission on mortality, discharge disposition, complications, length of stay (LOS), and total charges. Results: Of 47,114 patients, 31,711 (67.3 %) were direct-admits and 15,403 (32.7 %) were transfers. More transfer patients were coiled than direct-admits (45.3 vs. 33.7 %, p < 0.0001) and fewer underwent ventriculostomy (26.6 vs. 31.5 %, p = 0.003). Older age (OR 1.2, p < 0.0001), higher disease severity (OR 1.4, p < 0.0001), lower volume (OR 1.5, p < 0.0001), and ventriculostomy (OR 2.1, p < 0.0001) increased mortality and predicted non-routine discharge, complications, LOS, and charges. Transfer patients had similar mortality (OR 0.9, p = 0.13) and complications (OR 0.9, p = 0.22) as direct-admits, but incurred higher non-routine discharge (OR 1.3, p = 0.002). Analysis of grade V patients demonstrated similar outcomes between direct-admits and transfers; however, charges for treating transfer patients were notably higher (401,386 vs. 242,774, p = 0.03). Conclusion: Patients treated in the lowest volume hospitals were 1.6 times more likely to die than those treated at the highest quintile hospitals. Among the critically ill grade V patients, transfer to higher-volume specialized centers did not increase the likelihood of a poor prognosis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 312-323 |
| Number of pages | 12 |
| Journal | Neurocritical Care |
| Volume | 17 |
| Issue number | 3 |
| DOIs | |
| State | Published - Dec 1 2012 |
| Externally published | Yes |
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Keywords
- Clip
- Coil
- Complications
- Hospital volume
- Mortality
- Subarachnoid hemorrhage
- Total charges
- Transfer-effect
ASJC Scopus subject areas
- Clinical Neurology
- Critical Care and Intensive Care Medicine
Cite this
The effect of transfer and hospital volume in subarachnoid hemorrhage patients. / Nuno, Miriam A; Patil, Chirag G.; Lyden, Patrick; Drazin, Doniel.
In: Neurocritical Care, Vol. 17, No. 3, 01.12.2012, p. 312-323.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The effect of transfer and hospital volume in subarachnoid hemorrhage patients
AU - Nuno, Miriam A
AU - Patil, Chirag G.
AU - Lyden, Patrick
AU - Drazin, Doniel
PY - 2012/12/1
Y1 - 2012/12/1
N2 - Introduction: Prompt management of aneurysmal subarachnoid hemorrhage (SAH) is critical. Literature is inconclusive regarding outcomes for patients directly admitted to specialized centers versus transferred from lower-volume hospitals. Providers are often unclear about the safety of transferring critical patients. This study evaluated the "transfer effect" in a large sample of aneurysmal SAH patients undergoing treatment. Methods: Using Nationwide Inpatient Sample 2002-2007 data, we analyzed outcomes of SAH patients treated with coil or clip procedures. Analyses studied the effect of direct-admit versus transfer admission on mortality, discharge disposition, complications, length of stay (LOS), and total charges. Results: Of 47,114 patients, 31,711 (67.3 %) were direct-admits and 15,403 (32.7 %) were transfers. More transfer patients were coiled than direct-admits (45.3 vs. 33.7 %, p < 0.0001) and fewer underwent ventriculostomy (26.6 vs. 31.5 %, p = 0.003). Older age (OR 1.2, p < 0.0001), higher disease severity (OR 1.4, p < 0.0001), lower volume (OR 1.5, p < 0.0001), and ventriculostomy (OR 2.1, p < 0.0001) increased mortality and predicted non-routine discharge, complications, LOS, and charges. Transfer patients had similar mortality (OR 0.9, p = 0.13) and complications (OR 0.9, p = 0.22) as direct-admits, but incurred higher non-routine discharge (OR 1.3, p = 0.002). Analysis of grade V patients demonstrated similar outcomes between direct-admits and transfers; however, charges for treating transfer patients were notably higher (401,386 vs. 242,774, p = 0.03). Conclusion: Patients treated in the lowest volume hospitals were 1.6 times more likely to die than those treated at the highest quintile hospitals. Among the critically ill grade V patients, transfer to higher-volume specialized centers did not increase the likelihood of a poor prognosis.
AB - Introduction: Prompt management of aneurysmal subarachnoid hemorrhage (SAH) is critical. Literature is inconclusive regarding outcomes for patients directly admitted to specialized centers versus transferred from lower-volume hospitals. Providers are often unclear about the safety of transferring critical patients. This study evaluated the "transfer effect" in a large sample of aneurysmal SAH patients undergoing treatment. Methods: Using Nationwide Inpatient Sample 2002-2007 data, we analyzed outcomes of SAH patients treated with coil or clip procedures. Analyses studied the effect of direct-admit versus transfer admission on mortality, discharge disposition, complications, length of stay (LOS), and total charges. Results: Of 47,114 patients, 31,711 (67.3 %) were direct-admits and 15,403 (32.7 %) were transfers. More transfer patients were coiled than direct-admits (45.3 vs. 33.7 %, p < 0.0001) and fewer underwent ventriculostomy (26.6 vs. 31.5 %, p = 0.003). Older age (OR 1.2, p < 0.0001), higher disease severity (OR 1.4, p < 0.0001), lower volume (OR 1.5, p < 0.0001), and ventriculostomy (OR 2.1, p < 0.0001) increased mortality and predicted non-routine discharge, complications, LOS, and charges. Transfer patients had similar mortality (OR 0.9, p = 0.13) and complications (OR 0.9, p = 0.22) as direct-admits, but incurred higher non-routine discharge (OR 1.3, p = 0.002). Analysis of grade V patients demonstrated similar outcomes between direct-admits and transfers; however, charges for treating transfer patients were notably higher (401,386 vs. 242,774, p = 0.03). Conclusion: Patients treated in the lowest volume hospitals were 1.6 times more likely to die than those treated at the highest quintile hospitals. Among the critically ill grade V patients, transfer to higher-volume specialized centers did not increase the likelihood of a poor prognosis.
KW - Clip
KW - Coil
KW - Complications
KW - Hospital volume
KW - Mortality
KW - Subarachnoid hemorrhage
KW - Total charges
KW - Transfer-effect
UR - http://www.scopus.com/inward/record.url?scp=84874585597&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874585597&partnerID=8YFLogxK
U2 - 10.1007/s12028-012-9740-y
DO - 10.1007/s12028-012-9740-y
M3 - Article
C2 - 22843190
AN - SCOPUS:84874585597
VL - 17
SP - 312
EP - 323
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 3
ER -