Medical Student Geisel School of Medicine San Jose, CA, US
Introduction: Inter-hospital transfer of patients with spinal cord injuries is intended to provide access to healthcare. The rapidity and efficiency of the transfer process can greatly affect patient outcomes. The purpose of this study is to identify disparities in and potential factors associated with adverse outcomes in spinal cord injury patients who have undergone inter-hospital transfer.
Methods: Patients with initial and subsequent encounters focusing on cord injuries (using the appropriate Clinical Classification Software Refined codes) were selected from the National Inpatient Sample (NIS) 2018-2021, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Logistic and linear regression analyses were used to identify significant factors that are associated with the outcomes of inter-hospital transfer, mortality, length of stay, discharge disposition, and cost.
Results: An estimated weighted subpopulation of 52595 patients (unweighted population = 10,519) with spinal cord injuries was selected. Percent of patients who underwent inter-hospital transfer increased every year, averaging to 23.60% and peaking at 27.07% in 2021. Logistic regressions showed that patients admitted on weekends were less likely to have been transferred in (p < 0.001). Patients residing in increasingly rural communities (rather than more urban) as well as patients admitted to urban teaching hospitals (rather than rural hospitals) were more likely to have been transferred (p < 0.001). Further regressions showed that inter-hospital transfer was not significantly associated with mortality or total cost of admission, but was significantly associated with an increased length of stay (Linear Regression Coefficient = 3.04, 95% CI [2.18, 3.91], p < 0.001) as well as a routine disposition (OR = 1.25, 95% CI [1.10, 1.42], p = 0.001).
Conclusion : This preliminary study overall suggests that inter-hospital transfer of spinal cord injury patients is associated with an increased length of stay as well as a routine disposition. Inter-hospital transfer for these patients may not have a significant association with mortality or total cost. Further research into understanding discharge disposition of inter-hospital transfer of spinal injury patients is essential for addressing barriers and disparities in care, as well as improving outcomes.