Optimizing Spine Transfer Decisions: Assessing Appropriateness and Reducing Unnecessary Transfers
Rahul Ramanathan, Michelle Zhang, John Bonamer, Christopher Como, Yunting Tang, Anthony Oyekan, Christopher Gonzalez, Jacob Weinberg, Richard A. Wawrose, Joon Y. Lee, Jeremy D. ShawStudy Design:
Retrospective cohort study.
Objective:
To characterize spine-related interhospital transfers and evaluate whether a novel four-tier transfer classification framework identifies patients more likely to require inpatient surgical intervention.
Summary of Background Data:
Standardized criteria for spine transfer timing and setting remain limited. A reproducible framework that distinguishes patients requiring urgent tertiary evaluation from those potentially suitable for nonurgent or outpatient management could reduce avoidable transfers and improve allocation of specialized resources.
Methods:
A transfer database identified 1696 spine-related transfer requests between January 1, 2017, and December 31, 2022. The first 281 chronologically recorded requests were reviewed as a consecutive convenience sample. Patients younger than 18 years or without documented neurological examinations from the referring provider, accepting spine provider, or both were excluded. Transfers were classified as urgent transfer, nonurgent transfer, no transfer with outpatient follow-up, or no transfer without outpatient follow-up. Logistic regression evaluated associations between transfer classification, neurological deficit, and surgery during the index hospitalization. Model discrimination was assessed using the area under the receiver operating characteristic curve.
Results:
Of 281 records reviewed, 158 met inclusion criteria, and 54 patients underwent surgery (34.2%). Overall, 46.8% of transfers were classified as nonurgent and 31.0% as potentially suitable for outpatient evaluation without transfer. Accepting spine provider-documented neurological deficit was independently associated with surgery [adjusted odds ratio (OR): 4.23; 95% CI: 1.80–9.95;
Conclusions:
A substantial proportion of reviewed transfers were nonurgent or potentially suitable for outpatient evaluation. The proposed framework provides a strong foundation for standardized spine-transfer guidance and may help referring providers identify patients appropriate for immediate transfer, delayed tertiary evaluation, or outpatient management. Prospective external validation is required before clinical implementation.
Levels of Evidence:
Level III.