MMDA-27 INTERHOSPITAL TRANSFER AND IN-HOSPITAL OUTCOMES IN METASTATIC SPINAL DISEASE: A REPLICATION AND PROPENSITY SCORE-MATCHED EXTENSION USING THE NATIONAL INPATIENT SAMPLE (2012–2022)

Abstract

In patients with metastatic spinal disease (MSD), interhospital transfer has been shown to impact clinical outcomes such as complications, length of stay and nonroutine discharge, but not mortality. Critically, potential benefits of transfer to a higher level of care must be weighed against the negative effects of consequent delay in definitive treatment. The purpose of this study was to examine the impact of transfer status on inhospital mortality and clinical outcomes in patients with MSD. De la Garza Ramos et al. (2021) examined 10,360 National Inpatient Sample (NIS) discharges (2012–2014) and found that transferred patients had higher odds of complications (OR 1.34), prolonged length of stay (OR 1.33), and nonroutine discharge (OR 1.70), but no difference in mortality (OR 1.05, p = 0.662). In a retrospective study using the NIS, we replicated and extended these findings using a larger contemporary cohort with propensity score matching. Adult patients with bone metastasis, metastatic spinal cord compression or pathological vertebral fracture were identified using ICD-9-CM and ICD-10-CM codes. We first replicated the findings of De la Garza Ramos et al. from 2012–2014 (N = 11,132) and found that transferred patients had significantly higher adjusted odds of complications (OR 1.30), prolonged stay (OR 1.34), and nonroutine discharge (OR 1.64), with no mortality difference (OR 1.15, p = 0.230).We then extended this analysis for the years 2012-2022, and after propensity score matching (6,569 pairs), transfer was significantly associated with higher mortality (OR 1.49, 95% CI 1.30–1.70, p < 0.001), prolonged stay (OR 1.66), nonroutine discharge (OR 1.60), and complications (OR 1.16; all p < 0.001). It is also notable that transfer rates increased over the 2012-2014 study period. Given this, our updated results regarding the implications of interhospital transfer in MSD underscore the need to optimize transfer protocols and minimize delays in definitive care for patients with MSD.