title: Resource utilization and outcomes: effect of transfer on patients with ruptured abdominal aortic aneurysms.
abstract: We evaluated the transfer of patients with the diagnosis of a ruptured AAA (rAAA) from community centers to a tertiary care center. Our purpose was to identify factors associated with mortality and outcomes following the open repair of rAAA and to evaluate the differences between transferred and nontransferred patients. All patients who underwent repair of rAAA at our institution between 1995 and 2002 were retrospectively reviewed. Univariate and multivariate analysis was performed to identify patient specific factors on presentation and intraoperatively. Fifty-two patients underwent repair of rAAA, 20 patients were transferred to our institution. The overall mortality rate was 67%. The mortality rates for nontransferred and transferred groups were 69% and 65%, respectively. The incidence of mortality within 24 hr of surgery was significantly higher in the patients who were not transferred, 10 vs. 41% (p < 0.05). Patient-specific factors assessed for impact on survival by logistic regression included decreased body temperature on arrival to our institution (p = 0.02) and free rupture (p = 0.05). Of intraoperative factors tested, low systolic blood pressure was significantly associated with mortality (p = 0.05). No difference in total length of stay was noted. Transfer patients' length of stay in the intensive care unit was significantly greater than that of nontransferred patients (18.8 +/- vs. 7.3 +/- days, p < 0.05). The difference in ICU cost was dollar 36,000 among groups. We found the acceptance of transfer patients from community centers with rAAA did not adversely affect patient survival. Transferred patients had an over twofold increases in ICU days used. The identification of hypothermia was the single independent factor associated with poor survival and may be a marker for transfer selection. Given reduced reimbursements and increased utilization, tertiary care centers will need to consider the economic ramifications of accepting transfer patients with rAAA.
authors.affiliation: Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey--Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.forename: Gary B
authors.initials: GB
authors.lastname: Nackman
authors.forename: Lucy S
authors.initials: LS
authors.lastname: Brevetti
authors.forename: J G
authors.initials: JG
authors.lastname: Crowley
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Bueno
authors.forename: Adrienne
authors.initials: A
authors.lastname: Banavage
authors.forename: Karen
authors.initials: K
authors.lastname: Odroniec
authors.forename: Rocco G
authors.initials: RG
authors.lastname: Ciocca
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome