title: Impact of hospital transfer on surgical outcomes of intestinal atresia.
abstract: BACKGROUND
  Examine effects of hospital transfer into a quaternary care center on surgical outcomes of intestinal atresia.
  
  
  METHODS
  Children <1 yo principally diagnosed with intestinal atresia were identified using the Kids' Inpatient Database (2012). Exposure variable was patient transfer status. Outcomes measured were inpatient mortality, hospital length of stay (LOS) and discharge status. Linearized standard errors, design-based F tests, and multivariable logistic regression were performed.
  
  
  RESULTS
  1672 weighted discharges represented a national cohort. The highest income group and those with private insurance had significantly lower odds of transfer (OR:0.53 and 0.74, p < 0.05). Rural patients had significantly higher transfer rates (OR: 2.73, p < 0.05). Multivariate analysis revealed no difference in mortality (OR:0.71, p = 0.464) or non-home discharge (OR: 0.79, p = 0.166), but showed prolonged LOS (OR:1.79, p < 0.05) amongst transferred patients.
  
  
  CONCLUSIONS
  Significant differences in hospital LOS and treatment access reveal a potential healthcare gap. Post-acute care resources should be improved for transferred patients.
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA.
authors.forename: T
authors.initials: T
authors.lastname: Erickson
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Vana
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Blanco
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Brownlee
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
authors.forename: H N
authors.initials: HN
authors.lastname: Paddock
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA. Electronic address: paul.kuo@luhs.org.
authors.forename: P C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Kothari
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007182:Income; D007223:Infant; D007348:Insurance, Health; D007409:Intestinal Atresia / Q000401:mortality* / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010360:Patient Transfer; D017149:Private Sector; D012424:Rural Population; D014481:United States / Q000453:epidemiology
keywords: Atresia; Pediatrics; Regionalization; Surgery