Abstract Details

Title In-hospital Mortality, Resource Utilization and 30-Day Readmission among Patients with Intracerebral Hemorrhage Transferred to Centers with Higher Level of Care

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-033

Objective

We compare in-hospital mortality (IHM), resource utilization (RU), and 30-day readmission (RA) between transferred (TP) and non-transferred (nTP).

Background Intracerebral hemorrhage (ICH) patients are routinely transferred for Higher Level of Care (HLOC). Evidence of a transfer benefit by direct comparison of TP and non-transferred nTP patients is lacking.

Design/Methods

We identified discharges with diagnosis of ICH (ICD-9: 431) using NY, FL, and CA (2005 – 2014) State data. Patients <18 or with concurrent diagnoses of head trauma / arterio-venous malformations were excluded. As per comprehensive stroke center criteria, hospitals with an annual volume of ≥20 aneurysmal subarachnoid hemorrhages and ≥ 15 endovascular coiling / surgical clippings were classified as HLOC. Using unique linkage information, we tagged TP. Logistic regression was used to report adjusted odds ratios (aOR) and 95% confidence interval (CI) for association of IHM / 30-day RA with transfer status. Resource utilization (cost of care, ICU stay, CT/MRI use) was compared.

Results Among a total 124,557 patients, 84% presented at non-HLOC; of whom 19.2% were transferred (45.6% to HLOC). TP were younger, non-white, males, privately insured, with a lower co-morbidity burden. A greater proportion of TP underwent surgical procedures, ventricular drain and gastric tube placement. TP had longer length of stay, greater RU (head CT and MRI), and higher hospital charges. IHM was lower in TP as compared to nTP (22.2% vs 25.8%; aOR, CI: 0.85, 0.81 – 0.90); however, 30-day RA rates were not significantly different (16.24% vs 16.87%; aOR, CI: 0.96, 0.89 – 1.05). Detailed data on RU and transfer trend will be presented.

Conclusions Higher healthcare RU may be associated with IHM benefit for ICH patients transferred to HLOC; though lack of ICH severity data imposes limitation. Criteria for transfer of ICH patients and comparative effectiveness of their management at various levels of care needs to be prospectively studied.

Authors/Disclosures
PRESENTER	No disclosure on file
Jennifer Meeks	No disclosure on file
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Opeolu Adeoye	No disclosure on file
Osman Mir, MD (Texas Stroke Institute)	No disclosure on file
Louise D. McCullough, MD, PhD (McGovern Medical School, UTHealth)	The institution of Dr. McCullough has received research support from NIH. The institution of Dr. McCullough has received research support from American Heart Association.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.

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