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  • Subarachnoid Hemorrhage Patients: To Transfer or Not to Transfer?

    Final Number:

    Miriam Nuno PhD; Chirag G. Patil MD MS; Patrick Lyden; Doniel Drazin MD MA

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Prompt management of aneurysmal subarachnoid hemorrhage (SAH) is critical. The literature has been inconclusive regarding outcomes for patients directly-admitted to specialized centers versus those 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 (NIS) 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, in-hospital length of stay (LOS) and cost burden.

    Results: Of 47,114 patients, 31,711 (67.3%) were direct-admits and 15,403 (32.7%) were transfers. Transfer patients had similar mortality (OR 0.9, p=.13) and complications (OR 0.9, p=.22) as direct-admits. However, transfer patients incurred higher non-routine discharge (OR 1.3, p=.002) than direct-admits. Patients treated in lowest-quintile volume hospitals were 1.6 times more likely to die than those treated at the highest-quintile hospitals (OR 1.6, CI: 1.2-2.0, p=.002). Similar findings were observed when comparing patients treated in second-lowest quintile when compared to highest-volume hospitals (OR 1.4, CI: 1.0-1.9, p=.03). Transfer patients averaged 1 day longer in-hospital stays and $12,244 higher cost than direct-admit patients.

    Conclusions: Transfer patients had the same outcomes as the direct-admit SAH patients. Furthermore, we showed that high-volume hospitals had superior outcomes. Therefore, our study supports the growing centralization trend of lower volume hospitals to high volume SAH centers.

    Patient Care: This research will help practitioners to decide whether or not is is appropriate to transfer patients with subarachnoid hemorrhage.

    Learning Objectives: By the conclusion of this session participants will be able to the assess: (1) The effect of the transfer process in subarachnoid hemorrhage patients (2) To understand the role of hospital volume in determining outcomes of SAH patients (3) To understand the benefits of treatment centralization to higher-volume/specialized hospitals for SAH patients

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