Maria D Arulraja1, Morgan B Swanson2, Nicholas M Mohr3. 1. University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242, United States of America. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242, United States of America. Electronic address: morgan-bobb@uiowa.edu. 3. Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242, United States of America; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242, United States of America. Electronic address: nicholas-mohr@uiowa.edu.
Abstract
PURPOSE: Sepsis is a leading cause of hospital deaths. Inter-hospital transfer is frequent in sepsis and is associated with increased mortality. Some sepsis patients undergo two inter-hospital transfers (double transfer). This study assessed the (1) prevalence, (2) associated risk factors, (3) associated mortality, and (4) hospital length-of-stay and costs of double-transfer of sepsis patients. MATERIALS AND METHODS: Retrospective cohort study using 2005-2014 administrative claims data in Iowa. Multivariable generalized estimating equations adjusted for potential confounding variables, with a primary outcome of mortality. Secondary outcomes included hospital length-of-stay and costs. Hospital-specific cost-to-charge ratios estimated hospital costs. Hospitals were categorized into quintiles based on sepsis-volume. RESULTS: Of 15,182 sepsis subjects, there were 45.2% non-transfers and 2.1% double-transfers. Double-transfers had worse mortality than non-transfers but not single-transfers. Of the non-transfers, 44.9% presented to a top sepsis-volume hospital compared to 22.8% of double-transfers and 25.1% of single-transfers. After transfer from first to second hospital, 93.4% of the single-transfers and 92.2% of the double-transfers were at a top sepsis-volume hospital. Double-transfers had longer length-of-stay and more in total hospital costs than single-transfers. CONCLUSIONS: Double-transfer occurs in 2.1% of Iowa sepsis patients. Double-transfers had similar mortality and increased length of stay and costs compared to single-transfers.
PURPOSE:Sepsis is a leading cause of hospital deaths. Inter-hospital transfer is frequent in sepsis and is associated with increased mortality. Some sepsispatients undergo two inter-hospital transfers (double transfer). This study assessed the (1) prevalence, (2) associated risk factors, (3) associated mortality, and (4) hospital length-of-stay and costs of double-transfer of sepsispatients. MATERIALS AND METHODS: Retrospective cohort study using 2005-2014 administrative claims data in Iowa. Multivariable generalized estimating equations adjusted for potential confounding variables, with a primary outcome of mortality. Secondary outcomes included hospital length-of-stay and costs. Hospital-specific cost-to-charge ratios estimated hospital costs. Hospitals were categorized into quintiles based on sepsis-volume. RESULTS: Of 15,182 sepsis subjects, there were 45.2% non-transfers and 2.1% double-transfers. Double-transfers had worse mortality than non-transfers but not single-transfers. Of the non-transfers, 44.9% presented to a top sepsis-volume hospital compared to 22.8% of double-transfers and 25.1% of single-transfers. After transfer from first to second hospital, 93.4% of the single-transfers and 92.2% of the double-transfers were at a top sepsis-volume hospital. Double-transfers had longer length-of-stay and more in total hospital costs than single-transfers. CONCLUSIONS: Double-transfer occurs in 2.1% of Iowa sepsispatients. Double-transfers had similar mortality and increased length of stay and costs compared to single-transfers.
Authors: Craig M Lilly; Shawn Cody; Huifang Zhao; Karen Landry; Stephen P Baker; John McIlwaine; M Willis Chandler; Richard S Irwin Journal: JAMA Date: 2011-05-16 Impact factor: 56.272
Authors: Leah Feazel; Adam B Schlichting; Gregory R Bell; Dan M Shane; Azeemuddin Ahmed; Brett Faine; Andrew Nugent; Nicholas M Mohr Journal: Am J Emerg Med Date: 2015-05-29 Impact factor: 2.469
Authors: Barret Rush; Patrick D Tyler; David J Stone; Benjamin P Geisler; Keith R Walley; Leo Anthony Celi Journal: Crit Care Med Date: 2018-01 Impact factor: 7.598
Authors: Amy M J O'Shea; Spyridon Fortis; Mary Vaughan Sarrazin; Jane Moeckli; W C Yarbrough; Heather Schacht Reisinger Journal: J Crit Care Date: 2018-10-19 Impact factor: 3.425
Authors: Pratik B Doshi; Adam Y Park; Rosa C Banuelos; Bindu H Akkanti; Bryan F Darger; Annamaria Macaluso; Manoj Thangam; Kimberly A Chambers Journal: J Emerg Trauma Shock Date: 2018 Jul-Sep