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  • Impact of transfer status on hospitalization cost and discharge disposition of patients treated for acute ischemic stroke in the nation wide inpatient sample database,2008–2010

    Final Number:

    Ashish Sonig MD MS MCh neurosurgery; Ning Lin MD; Chandan Krishna MD; Sabareesh Kumar Natarajan MD MBBS MS; Maxim Mokin MD PhD; L. Nelson Hopkins MD; Kenneth V. Snyder MD, PhD; Elad I. Levy MD, FACS, FAHA, FAANS; Adnan Hussain Siddiqui MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: As the volume of stroke-interventions and case loads is increasing with time, knowledge of the proportion of patients who are transferred to a stroke-center from a primary-hospital and the differences in related costs and outcomes in transferred versus non-transferred patients are of paramount importance. In this study,we utilized the information provided in the NIS to study the impact of transferring a stroke patient from one facility to a center where they received some form of stroke intervention(intravenous tissue plasminogen activator[tPA],thrombectomy,either alone or in combination).

    Methods: We analyzed 2008–2010 NIS data. Figure1 gives the details of the variables used. Discharge-disposition, hospitalization-cost and mortality were the dependent variables that were studied. Univariate-analysis and multivariate-binary-logistic- regression analysis was done.

    Results: Data for 1,311,511 patients admitted for acute-stroke were reviewed from the 2008–2010 NIS database. The mean age of these patients was 71.11 years(standard deviation14.7,Figure2). We analyzed data for the cohort of patients(n=55,913) who received some form of active intervention(Figure3).When overall outcome was considered, patients with transfer-status had a significantly higher number of OTR(Other-then-routine) discharge-dispositions(p<0.0001)(Figure4).Multivariate-regression analysis that included pertinent patient(Figure5) and hospital-factors(factors6) showed that patients who were transferred had significant worse OTR (p<0.0001,OR2.575,CI 2.341–2.832)(Figure7) .The mean hospitalization-cost including an intervention was $70,325.11 at the direct-admission facility and $97,546.92 at the transfer-facility(figure8).Hospitalization-cost was analyzed, transfer from another facility (p<0.001,OR 1.677,CI 1.548–1.817) was associated with higher hospitalization cost (Figure9).

    Conclusions: Our study showed that the cost incurred by a hospital for acute-stroke intervention is significantly higher for a patient who is transferred from another facility than for a direct admission. Moreover, the frequency of OTR discharge was significantly higher among transferred patients compared with direct admissions. Future strategies should focus on the means and ways of transporting the patient appropriately and directly to a stroke center

    Patient Care: This current study shows the importance and overall cost effectiveness of the policy of transferring an acute stroke patient to a specialized center , directly.

    Learning Objectives: The reader would understand 1. The poor outcome and higher hospitalization cost of patients who are transferred from one facility to another for intervention vs a direct admission to a stroke intervention facility. 2. The regional disparity in the hospitalization of stroke patients

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