Effect of Transfer Status on Outcomes of Emergency General Surgery Patients

Philip, Jennifer L.; Yang, Dou‐Yan; Wang, Xing; Fernandes‐Taylor, Sara; Hanlon, Bret; Schumacher, Jessica R.; Saucke, Megan C.; Havlena, Jeffrey; Santry, Heena P.; Ingraham, Angela M.

doi:10.1016/j.surg.2020.01.005

Cited by 26 publications

(29 citation statements)

References 43 publications

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“…Several previously published studies have shown that the mortality rate is significantly increased in transfer patients. [8][9][10][11][12][13] Our 30-day mortality rate in the transfer cohort was 10.4%, slightly higher than the in-hospital mortality rate reported by Philip et al 5 in a single-center study, which included all transfers and not only surgically treated patients. Two recent analyses of the impact of the transfer process on mortality and complications of EGS patients using the Nationwide Inpatient Sample (NIS), a national administrative database with very limited clinical data, showed that the mortality rate of transfer patients varies from 4% to 4.5%; however, both studies included patients managed nonoperatively and analyzed only in-hospital outcome data.…”

Section: Discussioncontrasting

confidence: 56%

“…Several previously published studies have shown that the mortality rate is significantly increased in transfer patients 8–13 . Our 30-day mortality rate in the transfer cohort was 10.4%, slightly higher than the in-hospital mortality rate reported by Philip et al 5 in a single-center study, which included all transfers and not only surgically treated patients.…”

Section: Discussioncontrasting

confidence: 55%

“…9,10 The study by Philip et al, 5 using the NIS database, reported an overall complication rate of 38.8% in the transfer cohort and 26.1% in the direct admission group, compared with 18.9% and 6.7% in our study, respectively. 10 Differences in the data set and the complication types analyzed in the studies make it difficult to compare their results to ours. The mortality rate reported in our study is aligned with the report by Castillo-Angeles et al 11 These authors also used the NSQIP data set, although from an older period, ending in 2014.…”

Section: Discussioncontrasting

confidence: 44%

“…Unquestionably, increased mortality and complication rates, likely because of patient complexity (disease severity and comorbidities), have been reported by many authors studying the impact of transfers on EGS outcomes. An interesting component of this discussion is that approximately 10% to 25% of all transfers are deemed unnecessary, and many patients never undergo a surgical procedure at the definitive care facility 5–10 …”

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confidence: 99%

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The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter

Coimbra¹,

Barrientos²,

Allison-Aipa³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:The impact of interhospital transfer on outcomes of patients undergoing emergency general surgery (EGS) procedures is incompletely studied. We set out to determine if transfer before definitive surgical care leads to worse outcomes in EGS patients. METHODS:Using the National Surgical Quality Improvement Project database (2013-2019), a retrospective cohort study was conducted including nine surgical procedures encompassing 80% of the burden of EGS diseases, performed on an urgent/emergent basis. The procedures were classified as low risk (open and laparoscopic appendectomy and laparoscopic cholecystectomy) and high risk (open cholecystectomy, laparoscopic and open colectomy, lysis of adhesions, perforated ulcer repair, small bowel resection, and exploratory laparotomy). Time to surgery was recorded in days. The impact of interhospital transfer on outcomes (mortality, major complications, 30-day reoperations, and 30-day readmissions) and length of stay, according to procedure risk and time to surgery, were analyzed by multivariate logistic regression and inverse probability treatment of the weighting with treatment effect in the treated. RESULTS:A total of 329,613 patients were included in the study (284,783 direct admission and 44,830 transfers). Adjusted mortality (3.1% vs. 10.4%; adjusted odds ratio [AOR], 1.28; p < 0.001), major complications (6.7% vs. 18.9%; AOR, 1.39; p < 0.001), 30-day reoperations (3.1% vs. 6.4%; AOR, 1.22; p < 0.001), and length of stay (2 vs. 5) were higher in transferred patients. Transfer had no effect on 30-day readmissions (6% vs. 8.5%; AOR, 1.04; p = 0.063). These results were also observed in high-risk surgery patients and in the late surgery group. The results were further confirmed after robust propensity score weighting was performed. CONCLUSION:We have demonstrated that delays to surgical intervention affect outcomes and that interhospital transfer of EGS patients for definitive surgical care has a negative impact on mortality, development of postoperative complications, and reoperations in patients undergoing high-risk EGS procedures. These findings may have important implications for regionalization of EGS care.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussioncontrasting

confidence: 55%

Section: Discussioncontrasting

confidence: 44%

mentioning

confidence: 99%

See 2 more Smart Citations

The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter

Coimbra¹,

Barrientos²,

Allison-Aipa³

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…1,2 Emergency general surgury conditions are also associated with high mortality and costs, placing substantial burden on the health care system. 1,[3][4][5][6][7][8][9][10][11] Interhospital transfers of patients with EGS conditions are common, occurring in up to 13% of all EGS encounters, but little is known about the transfer patterns within the network. 1,12 Acute care hospitals with EGS services are not evenly distributed with regard to population density or need for care and, at present, there are no standardized guidelines in place to direct patients to those hospitals.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

et al. 2021

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IMPORTANCE Although patients with emergency general surgery (EGS) conditions frequently undergo interhospital transfers, the transfer patterns and associated factors are not well understood. OBJECTIVE To examine whether patients with EGS conditions are consistently directed to hospitals with more resources and better outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study performed a network analysis of interhospital transfers among adults with EGS conditions from January 1 to December 31, 2016. The analysis used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in 8 states. A total of 728 hospitals involving 85 415 transfers of 80 307 patients were included. Patients were eligible for inclusion if they were 18 years or older and had an acute care hospital encounter with a diagnosis of an EGS condition as defined by the American Association for the Surgery of Trauma. Data were analyzed from January 1, 2020, to June 17, 2021.EXPOSURES Hospital-level measures of size (total bed capacity), resources (intensive care unit[ICU] bed capacity, teaching status, trauma center designation, and presence of trauma and/or surgical critical care fellowships), EGS volume (annual EGS encounters), and EGS outcomes (riskadjusted failure to rescue and in-hospital mortality). MAIN OUTCOMES AND MEASURESThe main outcome was hospital-level centrality ratio, defined as the normalized number of incoming transfers divided by the number of outgoing transfers. A higher centrality ratio indicated more incoming transfers per outgoing transfer. Multivariable regression analysis was used to test the hypothesis that a higher hospital centrality ratio would be associated with more resources, higher volume, and better outcomes. RESULTS Among 80 307 total patients, the median age was 63 years (interquartile range [IQR], 50-75 years); 52.1% of patients were male and 78.8% were White. The median number of outgoing and incoming transfers per hospital were 106 (IQR, 61-157) and 36 (IQR, 8-137), respectively. A higher log-transformed centrality ratio was associated with more resources, such as higher ICU capacity (eg,

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Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations

Sohal,

Chaudhry,

Dukovic

et al. 2023

JGH Open

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Background and AimHepatorenal syndrome (HRS) is a life‐threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States.MethodsPatients with HRS were identified from the national inpatient sample 2016–2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non‐teaching hospitals (NTHs), teaching non‐transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in‐hospital mortality and transplant‐free mortality was examined using multivariable linear and logistic regression analysis.ResultsA total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non‐TTCs (aOR = 0.75, 95% CI: 0.68–0.83, P <0.001). Patients at TTCs had a lower transplant‐free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67–0.83, P < 0.001). There was no significant difference in all‐cause or transplant‐free mortality between TNTCs and NTHs.ConclusionPatients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS.

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Effect of Transfer Status on Outcomes of Emergency General Surgery Patients

Cited by 26 publications

References 43 publications

The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter

The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter

Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations

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