The Effect Of Interfacility Transfer In Patients With Blunt Thoracic Aortic Injury In The Vascular Quality Initiative
Kara A. Rothenberg, MD1, Elizabeth L. George, MD2, Vy T. Ho, MD2, Nicolas Barreto, MS3, Jason T. Lee, MD2, Jordan R. Stern, MD2.
1Department of Surgery, University of California San Francisco - East Bay, Oakland, CA, USA, 2Division of Vascular Surgery, Stanford University, Stanford, CA, USA, 3Stanford-Surgery Policy Improvement Research & Education Center, Stanford University, Stanford, CA, USA.
OBJECTIVES: TEVAR is the treatment of choice for the majority of patients with blunt thoracic injury (BTAI), and may require transfer to a specialized center. We sought to identify factors associated with interfacility transfer, and to evaluate the effect of transfer on outcomes.
METHODS: The Vascular Quality Initiative database was queried from 2013-2019 to identify patients who underwent TEVAR for BTAI. Associations between patient characteristics, injury grade, and transfer status were evaluated with Chi-square and Student’s independent t-tests. Covariates for a multivariable logistic regression model determining predictors for transfer were chosen based on univariate results and bidirectional stepwise logistic regression. Additional outcomes included in-hospital mortality and post-operative complications.
RESULTS: We included 664 patients (73.2% male, 64.6% white), of whom 262 (39.5%) were transferred. On univariate analysis, body mass index, race, injury grade, and injury severity score were all significantly associated with transfer status. On multivariable logistic regression, black race (OR 0.46, 95% CI [0.3-0.8]), Grade II (OR 0.40, 95% CI [0.2-0.8]) and Grade IV (OR 0.39, 95% CI [0.2-0.8]) BTAI remained independent predictors of non-transfer. However, patients who were transferred received significantly fewer blood transfusions (1.2 vs 2.5 units, p=0.001), had shorter procedure times (86.9 vs. 105.1 min, p=0.002), and had a significantly lower in-hospital mortality (4.2% vs 8.5%, p=0.03). When stratified by injury grade, only Grade III patients had lower mortality following transfer (3.4% vs. 9.8%, p=0.02).
CONCLUSIONS: Interfacility transfer for TEVAR after BTAI is associated with lower in-hospital mortality, especially for grade III injuries. Patients with grade II and IV injuries are least likely to be transferred, and there may be racial disparities associated.
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