Esteban Aguayo1, Oh Jin Kwon1, Vishal Dobaria1, Yas Sanaiha1, Joseph Hadaya1, Sohail Sareh2, Ashley Huynh1, Peyman Benharash3. 1. Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA. 2. Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA; Department of Surgery, Harbor University of California-Los Angeles, Torrance, CA. 3. Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA. Electronic address: Pbenharash@mednet.ucla.edu.
Abstract
BACKGROUND: The impact of interhospital transfers for extracorporeal life support have not been studied in large datasets. The present study sought to determine the impact of such patient transfers on survival, complications, and hospitalization costs. METHODS: The 2010 to 2016 database of the National Inpatient Sample was used to identify all adults who underwent extracorporeal life support. Patients were categorized based on whether or not they were transferred to another facility. Trend analysis and multivariable models were used to characterize the impact of inter hospital transfer on in-hospital mortality, complications, duration of stay, and costs. RESULTS: Of an estimated 29,298 extracorporeal life support hospitalizations during the study period, 36.8% were transferred from an outside facility. Extracorporeal life support hospitalizations experienced a 7-fold increase with no difference in mortality between transferred and not transferred cohorts in 2016 (4.79% vs 4.79%, P = .97). Mortality rates were less for patients transferred to high volume centers compared to low volume hospitals (48.7% vs 51.6%, P < .001). Transfer to a low volume hospital for cardiogenic shock was associated with greater odds of mortality (adjusted odds Rratio: 2.25, confidence interval 1.01-5.03). CONCLUSION: Utilization of extracorporeal life support in both transferred and not transferred patients has statistically significantly increased with a decrement in mortality for those transferred. Survival in the transferred cohort is strongly associated with extracorporeal life support procedure volume of the center and this must be taken into account when considering extracorporeal life support transfer.
BACKGROUND: The impact of interhospital transfers for extracorporeal life support have not been studied in large datasets. The present study sought to determine the impact of such patient transfers on survival, complications, and hospitalization costs. METHODS: The 2010 to 2016 database of the National Inpatient Sample was used to identify all adults who underwent extracorporeal life support. Patients were categorized based on whether or not they were transferred to another facility. Trend analysis and multivariable models were used to characterize the impact of inter hospital transfer on in-hospital mortality, complications, duration of stay, and costs. RESULTS: Of an estimated 29,298 extracorporeal life support hospitalizations during the study period, 36.8% were transferred from an outside facility. Extracorporeal life support hospitalizations experienced a 7-fold increase with no difference in mortality between transferred and not transferred cohorts in 2016 (4.79% vs 4.79%, P = .97). Mortality rates were less for patients transferred to high volume centers compared to low volume hospitals (48.7% vs 51.6%, P < .001). Transfer to a low volume hospital for cardiogenic shock was associated with greater odds of mortality (adjusted odds Rratio: 2.25, confidence interval 1.01-5.03). CONCLUSION: Utilization of extracorporeal life support in both transferred and not transferred patients has statistically significantly increased with a decrement in mortality for those transferred. Survival in the transferred cohort is strongly associated with extracorporeal life support procedure volume of the center and this must be taken into account when considering extracorporeal life support transfer.
Authors: Esther Dreier; Maximilian Valentin Malfertheiner; Thomas Dienemann; Christoph Fisser; Maik Foltan; Florian Geismann; Bernhard Graf; Dirk Lunz; Lars Siegfried Maier; Thomas Müller; Robert Offner; David Peterhoff; Alois Philipp; Bernd Salzberger; Barbara Schmidt; Barbara Sinner; Matthias Lubnow Journal: Perfusion Date: 2021-02-20 Impact factor: 1.972