Interhospital transfer of pediatric patients with malignant brain tumor not associated with increased mortality, but safe routine discharge

Shivani D. RangwalaDepartments of Neurological Surgery, and

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Jane S. HanDepartments of Neurological Surgery, and

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Li DingPreventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles; and

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William J. MackDepartments of Neurological Surgery, and

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Mark D. KriegerDivision of Neurological Surgery, Department of Surgery, Children’s Hospital of Los Angeles, California

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Frank J. AttenelloDepartments of Neurological Surgery, and

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OBJECTIVE

Interhospital transfer (IHT) to obtain a higher level of care for pediatric patients requiring neurosurgical interventions is common. Pediatric patients with malignant brain tumors often require subspecialty care commonly provided at specialized centers. The authors aimed to assess the impact of IHT in pediatric neurosurgical patients with malignant brain tumors to identify areas of improvement in treatment of this patient population.

METHODS

Pediatric patients (age < 19 years) with malignant primary brain tumors undergoing craniotomy for resection between 2010 and 2018 were retrospectively identified in the Nationwide Readmissions Database. Patient and hospital data for each index admission provided by the Nationwide Readmissions Database was analyzed by univariate and multivariate analyses. Further analysis evaluated association of IHT on specific patient- or hospital-related characteristics.

RESULTS

In a total of 2279 nonelective admissions for malignant brain tumors in pediatric patients, the authors found only 132 patients (5.8%) who underwent IHT for a higher level of care. There is an increased likelihood of transfer when a patient is younger (< 7 years old, p = 0.006) or the disease process is more severe, as characterized by higher pediatric complex chronic conditions (p = 0.0004) and increased all patient refined diagnosis-related group mortality index (p = 0.02). Patients who are transferred (OR 1.87, 95% CI 1.04–3.35; p = 0.04) and patients who are treated at pediatric centers (OR 6.89, 95% CI 4.23–11.22; p < 0.0001) are more likely to have a routine discharge home. On multivariate analysis, transfer status was not associated with a longer length of stay (incident rate ratio 1.04, 95% CI 0.94–1.16; p = 0.5) or greater overall costs per patient ($20,947.58, 95% CI −$35,078.80 to $76,974.00; p = 0.50). Additionally, IHT is not associated with increased likelihood of death or major complication.

CONCLUSIONS

IHT has a significant role in the outcome of pediatric patients with malignant brain tumors. Transfer of this patient population to hospitals providing subspecialized care results in a higher level of care without a significant burden on overall costs, risks, or mortality.

ABBREVIATIONS

APR-DRG = all patient refined diagnosis-related group; CCC = complex chronic condition; ICD-9-CM, ICD-10-CM = International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification; IHT = interhospital transfer; IRR = incident rate ratio; LOS = hospital length of stay; NRD = Nationwide Readmissions Database.

Supplementary Materials

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