Introduction: Spinal cord injury (SCI) results in significant morbidity and mortality, however the impact of patient transfer on outcomes has not been fully evaluated.
Methods: A retrospective review of patients with SCI and/or vertebral fracture (ICD-9CM codes 805, 806 and 952) was performed using the National Inpatient Sample (NIS) nationwide database review.
Results: A total of 53,644 patients were seen in Utah, with 11,235 cases of transferred patients and 5,721 cases of patients with SCI. Patients showed a mean age of 55.3±0.1 years (46.1% females, 90.2% white). Patients were divided by treatment in rural (n=4,420), urban non-teaching (25,072) and urban teaching (24,152) institutions. A decreased number of patients were seen transferring into facilities in 2011-2012 while an increased number transferred out in 2011-2012. Transferred patients showed greater likelihood of skill nursing or rehab facility disposition compared with admitted patients, specifically for urban non-teaching (57.4% vs. 36.8%) and urban teaching (44.3% vs. 55.4%) hospitals (p<0.0001). However, transferred patients showed reduce mortality compared with admitted patients for rural (0.0% vs. 2.1%), urban non-teaching (1.5% vs. 2.6%) and urban teaching (2.5% vs. 3.0%) hospitals (p<0.0001). A multivariable analysis showed that major operative procedures (HR=2.2, p=0.0001) and transfer status (p=0.4, p=0.0001) played the greatest affect on mortality after adjusting for other factors. An analysis of cost showed that disposition (ß=0.1), length of stay (ß=0.6), and major operative procedure (ß=0.3) (p=0.0001) affected cost. Geospatial modeling of hospitals in Utah showed that trends were stable over time and location.
Conclusions: Transferred patients showed a higher likelihood for poor outcome and increased cost compared to directly admitted patients. Improved interhospital transfer strategies may improve the timing of necessary surgical care and comprehensive, interdisciplinary SCI rehabilitation.
Patient Care: Understanding and updating the transfer process patients can improve morbidity, mortality and treatment costs. We aim for this work to better evaluate the referral process of patients in Utah in order to improve accessibility of care and earlier referrals for rehabilitation.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of transfer status on the outcomes and cost of patients with spinal cord injury.