2Department of Neurosurgery, Montefiore Medical Center, New York, New York.
Departments of1Neurosurgery and.
Neurosurg Focus. 2021 May;50(5):E4. doi: 10.3171/2021.2.FOCUS201085.
In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD.
The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes.
Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18-1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16-1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46-1.98, p < 0.001), with no significant difference in inpatient mortality rates.
Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.
在患有转移性脊柱疾病（MSD）的患者中，医院间的转移可能会影响临床结局，因为必须权衡将患者转移到更高水平的治疗所带来的潜在益处与治疗可能延迟相关的负面影响。虽然在其他专业领域已经研究了临床结局与转移状态之间的关系，但 MSD 患者的转移状态、并发症与死亡率之间的关系尚未得到探索。本研究的目的是探讨转移状态对诊断为 MSD 的患者的住院死亡率和临床结局的影响。
回顾性地从 2012 年至 2014 年全国（全美）住院患者样本（NIS）数据库中检索诊断为转移性疾病下的椎体病理性骨折和/或脊髓压迫的成年患者。在多变量逻辑回归模型中控制人口统计学、基线特征（如转移性脊髓压迫[MSCC]和瘫痪）、合并症、干预类型和相关患者结局，以分析转移状态与患者结局的关联。
在符合纳入和排除标准的 10360 名患者中，与直接入院的患者相比，在医院间转移的患者中观察到更高的 MSCC（50.2% vs 35.9%，p < 0.001）和瘫痪发生率（17.3% vs 8.4%，p < 0.001）。在单变量分析中，与直接入院的患者相比，接受转移的患者更有可能接受手术干预（p < 0.001）。在控制了显著的协变量和手术干预后，转移患者更有可能发生院内并发症（比值比 1.34，95%置信区间 1.18-1.52，p < 0.001）、住院时间延长（比值比 1.33，95%置信区间 1.16-1.52，p < 0.001）和出院去向非家庭（比值比 1.70，95%置信区间 1.46-1.98，p < 0.001），但住院死亡率无显著差异。
与直接入院的患者相比，在医院间转移的 MSD 患者表现出更严重的临床表现和更高的院内并发症发生率，尽管住院死亡率没有差异。
