S0734 Outcomes Following Inter-Hospital Transfer in Patients Admitted With Inflammatory Bowel Disease in the United States
Bibliographic record
Abstract
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)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".