Complications and surgical outcomes after interhospital transfer vs direct admission in colorectal surgery: A National Surgical Quality Improvement Program analysis

Sharp, Stephen P.; Ata, Ashar; Valerian, Brian T.; Canete, Jonathan J.; Chismark, A David; Lee, Edward C.

doi:10.1016/j.amjsurg.2016.08.013

Cited by 21 publications

(16 citation statements)

References 20 publications

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“…1 Surgical outcomes in urgent colorectal surgery transfers versus direct admissions. Bivariate and multivariable surgical outcomes for urgent interhospital transfers versus urgent direct admissions in the overall cohort, and the effect of elective operative status on surgical outcomes transferred patients still experienced higher rates of complications and worse outcomes, even after extensive propensity score matching [5], which was further confirmed by Chow et al [15]. One of the significant limitations with these studies was that the transfer cohort included a heterogeneous mix of both urgent and elective procedures.…”

Section: Discussionmentioning

confidence: 88%

Impact of Interhospital Transfer on Outcomes in Non‐emergency Colorectal Surgery

et al. 2017

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Transfer status alone confers minimal risk toward higher complication rates and longer hospital length of stay in patients undergoing urgent colorectal surgery, and the poor outcomes observed in this cohort are largely due to patient comorbidities and disease severity. Our results suggest that outcomes in transferred colorectal surgery patients undergoing urgent operations depend mainly on operative acuity and clinical factors, and to a lesser degree transfer status.

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Section: Discussionmentioning

confidence: 88%

Impact of Interhospital Transfer on Outcomes in Non‐emergency Colorectal Surgery

et al. 2017

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“…These findings confirm recent literature reporting associations between emergency admissions or transfers from other hospitals and 30-day-mortality, 5-year survival, complications, length of stay or morbidities. [7][8][9][10][11] Weekend surgery was associated with higher risks for death, postoperative respiratory and renal failure in both groups supported by the literature of mortality in colon 4 and general surgery. 5 6 Regarding rectum resections, the literature reported insignificant effects.…”

Section: Discussionmentioning

confidence: 57%

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

et al. 2022

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ObjectivesStudies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups is still scarce. Therefore the aim of this analysis was to investigate consistent relationships between multiple patient safety outcomes, healthcare and hospital risk factors in colorectal resection cases.DesignCross-sectional study.SettingGerman inpatient routine care data of colorectal resections between 2016 and 2018.ParticipantsWe analysed 54 168 colon resection and 20 395 rectum resection cases treated in German hospitals. The German Inpatient Quality Indicators were used to define colon resections and rectum resections transparently.Primary outcome measuresAdditionally to in-hospital death, postoperative respiratory failure, renal failure and postoperative wound infections we included multiple patient safety outcomes as primary outcomes/dependent variables for our analysis. Healthcare (eg, weekend surgery), hospital (eg, volume) and case (eg, age) characteristics served as independent covariates in a multilevel logistic regression model. The estimated regression coefficients were transferred into ORs.ResultsWeekend surgery, emergency admissions and transfers from other hospitals were significantly associated (ORs ranged from 1.1 to 2.6) with poor patient safety outcome (ie, death, renal failure, postoperative respiratory failure) in colon resections and rectum resections. Hospital characteristics showed heterogeneous effects. In colon resections hospital volume was associated with insignificant or adverse associations (postoperative wound infections: OR 1.168 (95% CI 1.030 to 1.325)) to multiple patient safety outcomes. In rectum resections hospital volume was protectively associated with death, renal failure and postoperative respiratory failure (ORs ranged from 0.7 to 0.8).ConclusionsTransfer from other hospital and emergency admission are constantly associated with poor patient safety outcome. Hospital variables like volume, ownership or localisation did not show consistent relationships to patient safety outcomes.Trial registration numberISRCTN10188560.

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“…In 2017, three separate studies of patients requiring colorectal surgery, all using data from the American College of Surgeons National Surgical Quality Improvement Program came to conflicting conclusions regarding the contributions of patient factors and transfer status. 2,18,19 All three found that patients transferred had worse outcomes, but there was no consensus across studies on the primary cause of these findings. The present analysis is uniquely positioned to add perspective to this uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Impact of transfer status on real-world outcomes in nonelective cardiac surgery

Beller

Hawkins

Mehaffey

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective-Transfer from hospital to hospital for cardiac surgery represents a large portion of some clinical practices. Previous literature in other surgical fields has shown worse outcomes for patients transferred. We hypothesized that transferred patients would be higher risk and demonstrate worse outcomes than those admitted through the emergency department.Methods-All patients undergoing cardiac operations with a Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) were evaluated from a multicenter, statewide STS database. Only patients requiring admission prior to surgery were included. Patients were stratified by admission through the emergency department or in transfer. Transfers were further stratified by the cardiothoracic surgery capabilities at the referring center.Results-A total of 13,094 patients met the inclusion criteria of admission prior to surgery. This included 7,582 (57.9%) transfers, of which 502 (6.6%) were referred from cardiac centers. Compared to emergency department admissions, transfers had increased hospital costs despite lower operative risk (PROM 1.5% vs. 1.6%, p<0.01) and equivalent postoperative morbidity (15.6% vs. 15.3% p=0.63). In risk adjusted analysis, transfer status was not independently associated with worse outcomes. Patients transferred from centers that perform cardiac surgery are higher risk than general transfers (PROM 2.5% vs. 1.5, p<0.01), but specialized care results in excellent risk adjusted outcomes (O/E: Mortality 0.81; Morbidity or Mortality 0.90).Conclusions-Transfer patients have similar rates of postoperative complications but increased resource utilization compared to patients admitted through the emergency department. Importantly, patients transferred from centers that perform cardiac surgery represent a particularly high-risk subgroup.

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Complications and surgical outcomes after interhospital transfer vs direct admission in colorectal surgery: A National Surgical Quality Improvement Program analysis

Cited by 21 publications

References 20 publications

Impact of Interhospital Transfer on Outcomes in Non‐emergency Colorectal Surgery

Impact of Interhospital Transfer on Outcomes in Non‐emergency Colorectal Surgery

Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals

Impact of transfer status on real-world outcomes in nonelective cardiac surgery

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