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. 2022 Oct;66(9):1107-1115.
doi: 10.1111/aas.14129. Epub 2022 Aug 28.

Comparison of patient characteristics and long-term mortality between transferred and non-transferred COVID-19 patients in Dutch intensive care units: A national cohort study

Safira A Wortel  1   2   3 , Ferishta Bakhshi-Raiez  1   2   3 , Fabian Termorshuizen  1   2 , Dylan W de Lange  3   4 , Dave A Dongelmans  2   3   5 , Nicolette F de Keizer  1   2   3 ; Dutch COVID-19 Research Consortium
Collaborators, Affiliations

Comparison of patient characteristics and long-term mortality between transferred and non-transferred COVID-19 patients in Dutch intensive care units: A national cohort study

Safira A Wortel et al. Acta Anaesthesiol Scand. 2022 Oct.

Abstract

Background: COVID-19 patients were often transferred to other intensive care units (ICUs) to prevent that ICUs would reach their maximum capacity. However, transferring ICU patients is not free of risk. We aim to compare the characteristics and outcomes of transferred versus non-transferred COVID-19 ICU patients in the Netherlands.

Methods: We included adult COVID-19 patients admitted to Dutch ICUs between March 1, 2020 and July 1, 2021. We compared the patient characteristics and outcomes of non-transferred and transferred patients and used a Directed Acyclic Graph to identify potential confounders in the relationship between transfer and mortality. We used these confounders in a Cox regression model with left truncation at the day of transfer to analyze the effect of transfers on mortality during the 180 days after ICU admission.

Results: We included 10,209 patients: 7395 non-transferred and 2814 (27.6%) transferred patients. In both groups, the median age was 64 years. Transferred patients were mostly ventilated at ICU admission (83.7% vs. 56.2%) and included a larger proportion of low-risk patients (70.3% vs. 66.5% with mortality risk <30%). After adjusting for age, APACHE IV mortality probability, BMI, mechanical ventilation, and vasoactive medication use, the hazard of mortality during the first 180 days was similar for transferred patients compared to non-transferred patients (HR [95% CI] = 0.99 [0.91-1.08]).

Conclusions: Transferred COVID-19 patients are more often mechanically ventilated and are less severely ill compared to non-transferred patients. Furthermore, transferring critically ill COVID-19 patients in the Netherlands is not associated with mortality during the first 180 days after ICU admission.

Keywords: COVID-19; intensive care unit; intrahospital transfer; mortality; severity of illness.

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Conflict of interest statement

Nicolette F. de Keizer, Dylan W. de Lange, and Dave A. Dongelmans are members of the board of the Dutch National Intensive Care Evaluation (NICE) foundation. The NICE foundation pays the Department of Medical Informatics, Amsterdam UMC, for processing data of all Dutch ICUs into audit and feedback information. Safira A. Wortel, Nicolette F. de Keizer, Fabian Termorshuizen, and Ferishta Bakhshi‐Raiez are employees of the Department of Medical Informatics and work on the NICE project.

Figures

FIGURE 1
FIGURE 1
Patient selection. Flowchart illustrating the patient inclusion and exclusion criteria for this study. APACHE, Acute Physiology and Chronic Health Evaluation; COVID‐19, coronavirus disease 2019; ICU, intensive care unit
FIGURE 2
FIGURE 2
Number of COVID‐19 transfers between hospital types. (Gray) Number of transfers from general peripheral hospitals to other hospital types. For example, at the top right >550 patients were transferred from general peripheral hospitals to academic teaching hospitals and >250 patients were transferred within general peripheral hospitals. (Black) Number of transfers from teaching hospitals (academic) to other hospital types. For example, <100 patients were transferred from academic teaching hospitals to general peripheral hospitals, non‐academic teaching hospitals, and other academic hospitals. (Blue) Number of transfers from teaching hospitals (non‐academic) to other hospital types. For example, from the bottom left >550 patients are transferred from non‐academic teaching hospitals to academic hospitals
FIGURE 3
FIGURE 3
180‐day survival of transferred and non‐transferred COVID‐19 patients. Kaplan–Meier survival curves of transferred (red) and non‐transferred (black) COVID‐19 patients. Left truncation was applied, so the survival curve of the non‐transferred patients starts at the first day of intensive care unit (ICU) admission while the survival curve of the transferred patients starts at the day of the first ICU transfer
See this image and copyright information in PMC

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