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Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis.
Crit Care Med. 2018 01; 46(1):e81-e86.CC

Abstract

OBJECTIVES

The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit.

DESIGN

Retrospective data analysis using complex survey design regression methods with propensity score matching.

SETTING

The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across 1 year of follow-up.

PATIENTS

From the 2013 Nationwide Readmission Database Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on mechanical ventilation. Of these, 1,630 patients (2.7%) were transferred during their hospitalization. A propensity-matched cohort of 1,630 patients who did not undergo interhospital transfer was identified.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The exposure of interest was interhospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay. The propensity score included age, gender, insurance coverage, do not resuscitate status, use of renal replacement therapy, presence of shock, and Elixhauser comorbidities index. After propensity matching, interhospital transfer was not associated with a difference in in-hospital mortality (12.3% interhospital transfer vs 12.7% non-interhospital transfer; p = 0.74). However, interhospital transfer was associated with a longer total hospital length of stay (12.8 d interquartile range, 7.7-21.6 for interhospital transfer vs 9.1 d interquartile range, 5.1-17.0 for non-interhospital transfer; p < 0.01).

CONCLUSIONS

Patients with sepsis requiring mechanical ventilation who underwent interhospital transfer did not have improved outcomes compared with a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of interhospital transfer as an intervention.

Authors+Show Affiliations

Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, BC, Canada.Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA.Department of Medicine, Massachusetts General Hospital, Boston MA.Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, BC, Canada.Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29068858

Citation

Rush, Barret, et al. "Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: a Nationwide Linked Analysis." Critical Care Medicine, vol. 46, no. 1, 2018, pp. e81-e86.
Rush B, Tyler PD, Stone DJ, et al. Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Crit Care Med. 2018;46(1):e81-e86.
Rush, B., Tyler, P. D., Stone, D. J., Geisler, B. P., Walley, K. R., & Celi, L. A. (2018). Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Critical Care Medicine, 46(1), e81-e86. https://doi.org/10.1097/CCM.0000000000002777
Rush B, et al. Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: a Nationwide Linked Analysis. Crit Care Med. 2018;46(1):e81-e86. PubMed PMID: 29068858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. AU - Rush,Barret, AU - Tyler,Patrick D, AU - Stone,David J, AU - Geisler,Benjamin P, AU - Walley,Keith R, AU - Celi,Leo Anthony, PY - 2017/10/27/pubmed PY - 2017/12/28/medline PY - 2017/10/26/entrez SP - e81 EP - e86 JF - Critical care medicine JO - Crit Care Med VL - 46 IS - 1 N2 - OBJECTIVES: The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit. DESIGN: Retrospective data analysis using complex survey design regression methods with propensity score matching. SETTING: The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across 1 year of follow-up. PATIENTS: From the 2013 Nationwide Readmission Database Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on mechanical ventilation. Of these, 1,630 patients (2.7%) were transferred during their hospitalization. A propensity-matched cohort of 1,630 patients who did not undergo interhospital transfer was identified. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure of interest was interhospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay. The propensity score included age, gender, insurance coverage, do not resuscitate status, use of renal replacement therapy, presence of shock, and Elixhauser comorbidities index. After propensity matching, interhospital transfer was not associated with a difference in in-hospital mortality (12.3% interhospital transfer vs 12.7% non-interhospital transfer; p = 0.74). However, interhospital transfer was associated with a longer total hospital length of stay (12.8 d interquartile range, 7.7-21.6 for interhospital transfer vs 9.1 d interquartile range, 5.1-17.0 for non-interhospital transfer; p < 0.01). CONCLUSIONS: Patients with sepsis requiring mechanical ventilation who underwent interhospital transfer did not have improved outcomes compared with a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of interhospital transfer as an intervention. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/29068858/Outcomes_of_Ventilated_Patients_With_Sepsis_Who_Undergo_Interhospital_Transfer:_A_Nationwide_Linked_Analysis_ L2 - https://dx.doi.org/10.1097/CCM.0000000000002777 DB - PRIME DP - Unbound Medicine ER -