Interhospital transfer for intact XXXX repair.

@entity1 @entity712 @entity260 @entity177 @entity439 @entity1028
OBJECTIVE: Medically complex @entity1 who need @entity1028 ( @entity1028 ) repair are at increased risk of mortality. We study the effects of interhospital transfer to high-volume hospitals (HVHs) on @entity260 and mortality after complications in these @entity1 . METHODS: Data for 491,779 @entity1 undergoing intact @entity1028 surgery were extracted using Medicare files. @entity1 demographics, comorbidities, hospital volume, repair type, and @entity1 transfer status were collected. Primary outcomes were @entity260 and failure to rescue within 30  days after surgery. Data were analyzed using multivariable and propensity analysis. RESULTS: From 2000 to 2011, the percentage of @entity1 transferred to another hospital for surgery before starting treatment more than doubled from .7% to 1.9% for @entity439 repair (EVAR; P  < .001) and from 1.2% to  3.7% for open repair (P  < .001). At baseline, transferred @entity1 had more @entity712 (18.7% vs 11.2%; P  < .001), coronary (17.4% vs 15.0%; P  < .001), pulmonary (38.3% vs 33.6%; P  < .001), and @entity177 (8.1% vs 4.6%; P  < .001) comorbidities. Transferred @entity1 incurred more complications after EVAR (25.1% vs 12.8%; P  < .001) or open repair (42.3% vs 35.5%; P  < .001). After propensity matching for comorbidities and demographics, there were fewer complication rates (40.4% vs 47.8%; P  < .001) and decreased failure to rescue (5.5% vs 6.5%; P  = .04) after open repair in  @entity1 transferred to HVHs than in @entity1 who remained at the primary, low-volume hospital for surgery. Complication rates after EVAR for nontransferred @entity1 at low-volume hospitals and transferred @entity1 at HVHs were similar (23.9% vs 24.7%; P  = .55). After propensity matching, there was no significant difference in failure to rescue (P  = .06) after EVAR between @entity1 transferred to HVHs and nontransferred @entity1 who had procedures at low-volume hospitals. CONCLUSIONS: Transfer of medically complex @entity1 to HVHs for open @entity1028 repair improves outcomes in @entity1028 surgery. Complication rates decrease, and survival of transferred @entity1 increases when they undergo open repair at HVHs.
