• Ida Azizkhanian, Michael Rothbaum, Ryan Alcantara, Zachary Ballinger, Edward Cho, Silvi Dore, Stergios Gatzofilas, Raeesa Habiba Hossain, Jesse Honig, Nicole Matluck, Jonathan Ogulnick, Harrison Smith, Brian Tung, Ivan Miller, Meic H Schmidt, Chad D Cole, and Christian A Bowers.
• New York Medical College, Valhalla, New York, USA.
• World Neurosurg. 2020 Dec 1; 144: e221-e226.

ObjectiveInterhospital patient transfer (IHT) of patients is common and accounts for a significant portion of health care costs, yet the variables driving neurosurgical IHT have not been systematically described. We analyzed variables that distinguished spine surgery patients who underwent IHT from patients who did not undergo IHT to report on the effect of frailty on IHT.MethodsA retrospective chart review was performed to collect data on consecutive patients undergoing spinal procedures during 2015-2017. IHT patients were identified and compared with non-interhospital patient transfer (n-IHT) patients to identify factors that distinguished the 2 patient groups using multivariate regression analysis. Studied variables included case complexity, frailty (modified frailty index), age, insurance status, and baseline demographic variables. Postoperative outcomes affected by transfer status were identified in binary regression analysis.ResultsDuring 2015-2017, there were 595 n-IHT and 76 IHT spine surgery patients (N = 671). Increased frailty (modified frailty index ≥3; odds ratio = 2.4, P = 0.01) and increased spine surgery complexity (spine surgery complexity score ≥2; odds ratio = 2.57, P = 0.002) were independent risk factors associated with IHT. IHT was an independent risk factor for increased hospital length of stay and increased postoperative complications (Clavien-Dindo scale; P < 0.001).ConclusionsIHT patients comprise a more frail and surgically complex surgical spine population compared with n-IHT patients. IHT was also an independent risk factor for increased complications and length of stay after spine surgery. Patients' insurance status and age did not distinguish between IHT and n-IHT groups. This is the first report in any specialty to demonstrate increasing frailty is associated with IHT.Copyright © 2020 Elsevier Inc. All rights reserved.

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