Medical Student University of Florida College of Medicine Gainesville, Florida, United States
Introduction: Non-traumatic subdural hemorrhage (ntSDH) is common in the elderly population and associated with significant morbidity and mortality. Patients often require immediate surgical intervention that may not be available at community hospitals and are therefore transferred to tertiary care centers. The effects of interhospital transfer (IHT) on complications and outcomes following ntSDH has not been explored.
Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent craniotomy or craniectomy for evacuation of ntSDH (CPT codes 61312, 61314) and 715 patients were identified. Baseline demographics, clinical characteristics, and outcomes including complications were compared based on IHT status. Univariate and multivariate logistic regression analyses were performed. Effect sizes in the final model were presented as odds ratio (OR) with associated 95% confidence interval (CI).
Results: Of the 715 patients, 295 (41%) were in the IHT group. There was no significant difference between groups in terms of demographics (age, sex, race, ethnicitiy), clinical characteristics (BMI, comorbidities, frailty status, ntSDH type) or operative factors (time to surgery and operative time). In the final multivariate model adjusted for covariates, IHT status was independently associated with increased risk for postoperative sepsis (OR: 1.367, CI: 1.084-1.725, p=0.009), non-home discharge disposition (OR: 1.139, CI: 1.046-1.239, p=0.003) and 30-day mortality (OR: 1.203, CI: 1.044-1.386, p=0.011).
Conclusion : This analysis suggests that despite similar baseline characteristics, patients transferred for ntSDH treatment appear to have worse postoperative outcomes. Future study focusing on patients in the IHT group to identify factors associated with poor outcome is warranted.
