9 Predictors of Hospital Transfer and Associated Risks of Mortality in Acute Pancreatitis

Abstract

INTRODUCTION: There is limited data available on which patients are most likely to be transferred to tertiary acute care hospitals and their outcomes in acute pancreatitis (AP). We sought to determine predictors of hospital transfer in AP from small/medium sized hospitals to other acute care hospitals and determine if those patients incur higher rates of mortality. METHODS: Using the Nationwide Inpatient Sample (2011–2013, age ≥18 years), patients hospitalized with AP were identified. Baseline demographic and hospital characteristics, etiology, related procedures, transfer rates, and mortality data were collected. Hospital size was defined by the Agency for Healthcare Research and Quality (Table 1). Patients with pregnancy, pancreatic neoplasms, chronic pancreatitis, and history of bariatric surgery were excluded. Two different multivariate analyses were performed. RESULTS: There were 381,818 patients admitted with AP to small/medium sized hospitals where the mortality rate was 0.81% (n: 3,101). The rate of “transfer-out” to acute care hospitals was 4% (n: 13,947). Multivariate analysis for the outcome of “transfer-out” from small/medium to acute care hospitals revealed that older patients (OR for a 5-year increase 1.04; 95% CI 1.03–1.06), men (OR 1.15; 95% CI 1.06–1.24), lower income quartiles (OR 1.45; 95% CI 1.33–1.59), admission to a non-teaching hospital (OR 3.38; 95% CI 3.00–3.80), gallstone pancreatitis (OR 3.32; 95% CI 2.91–3.79), pancreatic surgery (OR 3.13; 95% CI 1.76–5.56), and severe AP (OR 3.06; 95% CI 2.78–3.37) were independent predictors of transfer. ERCP (OR 0.53; 95% CI 0.43–0.66) and cholecystectomy (OR 0.14; 95% CI 0.12–0.18) were associated with decreased odds of “transfer-out.” There were 507,439 patients admitted with AP to large hospitals and 6.1% (n: 31,025) were “transferred-in” from other hospitals. The mortality rate among those transferred in was higher than those directly admitted (2.54% vs. 0.91%, P < 0.001). After adjusting for confounding factors (Table 2), being “transferred-in” from other hospitals was an independent predictor of mortality (OR 1.47; 95% CI 1.22–1.77). CONCLUSION: Transfer of patients with AP from lower to higher acuity of care adversely impacts mortality. Implementation of published clinical guidelines, early triage and transfer of high-risk patients can potentially offset adverse hospital outcomes.