Interfacility transfer and mortality for patients with ruptured abdominal aortic aneurysm

Area of Science:

• Vascular Surgery
• Health Services Research
• Healthcare Quality Improvement

Background:

• Interfacility transfer for ruptured abdominal aortic aneurysms (rAAA) involves a significant patient minority.
• These transferred patients are often excluded from outcomes and quality indicator studies.
• Characterizing outcomes and resource utilization for transferred rAAA patients is critical.

Purpose of the Study:

• To compare mortality and resource utilization between rAAA patients transferred for care and those treated without transfer.
• To identify factors associated with interfacility transfer for rAAA.
• To evaluate the impact of transfer on in-hospital mortality, length of stay, and cost.

Main Methods:

• Utilized longitudinal data from 2005-2010 HCUP databases (California, Florida, New York).
• Identified rAAA patients using ICD-9-CM codes.
• Analyzed mortality, length of stay, and cost using univariate and multivariate analyses, accounting for transfer status.

Main Results:

• 19.1% of rAAA patients were transferred before repair; 17% of these died without surgery.
• Transfer was associated with lower operative mortality but increased overall mortality (OR 1.30).
• Transferred patients had longer lengths of stay (median 10 vs 9 days) and higher costs ($161K vs $146K).

Conclusions:

• The transfer process for rAAA repair increases overall mortality and hospital resource utilization.
• The survival benefit for transferred patients who received treatment was outweighed by the increased mortality associated with the transfer process.
• Optimizing interfacility transfer systems and guidelines is essential to improve rAAA patient outcomes and reduce resource consumption.