Interhospital transfer of patients with malignant brain tumors undergoing resection is associated with routine discharge

Abstract

IntroductionNeurosurgical patients often undergo interhospital transfer (IHT) for specialized care. While IHT is often associated with worse outcomes in emergent neurosurgical conditions, less is known about patient outcomes after IHT for urgent diagnoses such as brain tumors. We sought to evaluate patient outcomes after IHT for malignant brain tumor resection. MethodsPatients hospitalized for resection of malignant brain tumor resections were analyzed from the Nationwide Readmissions Database (NRD) from 2016 to 2018. Multivariate regression analyses were conducted to determine associations between transfer status and routine disposition, mortality index, and length of stay. ResultsAmong 13,173 patients with non-elective admissions for malignant brain tumor resection, 1583 (12.0%) were transferred from another facility. In comparison to non-transferred patients, IHT patients were more likely to be male (53.8% vs. 51.1%, p < 0.04), older (rates of age ≥60 64.0% vs. 58.9%, p < 0.001), and had greater Elixhauser comorbidity scores (≥3: 75.0% vs. 56.1%, p < 0.0001). After adjustment for comorbidity burden, transfer status was associated with increased likelihood of routine discharge (OR 1.35, 95% CI 1.18–1.55, p < 0.0001). Mortality was similar for IHT patients compared to non-transferred patients (OR 0.87, CI 0.62–1.22, p = 0.405). Transfer status was associated with increased length of stay (incident rate ratio [IRR] 1.41, 95% CI 1.34–1.48, p < 0.0001). ConclusionIHT for malignant brain tumor resection was not associated with worse patient outcomes with respect to discharge disposition and mortality. Length of stay was greater for IHT patients. Further research is needed to determine which patients will benefit from IHT for malignant brain tumor resection.