S0734 Outcomes Following Inter-Hospital Transfer in Patients Admitted With Inflammatory Bowel Disease in the United States
Notice bibliographique
Résumé
INTRODUCTION: Outcomes in inflammatory bowel disease (IBD) patients who get transferred to new hospitals have not been well described. Using a national dataset, we sought to describe trends and outcomes in IBD transfers in the United States. METHODS: Adults with IBD (defined with ICD-9 codes for Crohn’s Disease - CD and Ulcerative Colitis -UC) were identified in the 2007–2014 National Inpatient Sample. Trends in inter-hospital IBD transfers, along with patient and hospital-level descriptors were examined. A cohort of patients who received IBD-related surgery at the recipient hospital was also identified (IBD-surgical transfers). Outcomes including all-cause in-hospital mortality, length of stay (LOS), and total hospital costs (THC) in IBD transfers were then assessed after controlling for confounding variables. RESULTS: We identified 793,015 IBD discharges of which 519, 598 (65.5%) were for CD and 273,417 (34.5%) for UC. 3.4% of IBD patients (n = 27,005) were transferred to a recipient hospital; of these, 15.1% (n = 4,090) underwent an IBD-related surgery at the new hospital. Between 2007- 2014, there was a rise in all IBD and IBD-surgical transfers in the US (P = 0.02, Figure 1). In IBD-surgical transfer patients, the mean age at transfer was 41 years with most patients being White (80.6%), on private insurance (52.5%), and living below the median level of income (56.2%) (Table 1). Twenty-three percent of IBD-surgical transfers occurred during the weekends, predominantly to teaching hospitals (90%), with 36% transferred to low/medium-volume IBD hospitals. Interestingly, the adjusted odds of all-cause in-hospital mortality was higher in IBD-transfer patients (adjusted Odds Ratio 3.36, 95% Confidence Interval 2.3–4.8), however, within this transfer cohort, IBD-surgical transfers did not demonstrate a mortality risk though they had higher odds of post-surgical complications, LOS and total hospital costs (Table 2). Small and large bowel resections formed the bulk of surgery (73%) done in CD transfers, while total abdominal colectomy, ileostomy and rectal stump creation formed the bulk of surgeries (94%) in UC-transfer patients. CONCLUSION: Inter-hospital transfers for IBD are on the rise in the US. These patients are a high-risk group with significantly higher odds of in-hospital death except in transfers that undergo an IBD-related surgery at the new hospital. More research is needed to identify high-performing recipient hospitals to improve IBD outcomes.Figure 1.: Trends in inter-hospital transfer of inflammatory bowel disease (IBD) patients.Table 1.: Baseline demographics and comorbidity of inter-hospital transfer patients with inflammatory bowel disease (IBD)Table 2.: Crude and adjusted odds ratio and mean ratios of outcomes of inter-hospital transfer patients with inflammatory bowel disease (IBD)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».