Impact of interhospital transfer on patient outcomes in emergency general surgery

Allen, Laura; Vogt, Kelly; Joos, Émilie; Heest, Rardi van; Saleh, Fady; Widder, Sandy; Hameed, Morad; Parry, Neil; Minor, Sam; Murphy, Patrick

doi:10.1016/j.surg.2020.08.032

Cited by 18 publications

(18 citation statements)

References 16 publications

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“…Several studies have demonstrated interhospital transfer to be associated with increased risk of mortality or complications. 8 , 19 , 20 , 21 In the present work, survival rates for transported patients were comparable to all-comers as reported by ELSO as well as to those cannulated at our institution. This may be related to team expertise in selection, cannulation, and management.…”

Section: Discussionsupporting

confidence: 86%

Implementation and outcomes of an urban mobile adult extracorporeal life support program

Hadaya¹,

Sanaiha²,

Gudzenko³

et al. 2022

JTCVS Techniques

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Section: Discussionsupporting

confidence: 86%

Implementation and outcomes of an urban mobile adult extracorporeal life support program

Hadaya¹,

Sanaiha²,

Gudzenko³

et al. 2022

JTCVS Techniques

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“…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%

“…[5][6][7][8] Several studies have analyzed the impact of transfers on EGS mortality and complication rates. [8][9][10][11][12][13] Most of those studies have used national data from administrative databases lacking clinical granularity or individual hospital data with good clinical granularity but insufficient robustness to assert generalizability. However, such studies have been essential to highlight hospital and patient-level factors leading to transfers.…”

mentioning

confidence: 99%

“…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][6][7][8][9][10] The transfer of EGS patients impacts more than just mortality and complication rates; however, detailed data on other outcome measures are still lacking. For instance, only one study has assessed the impact of transfers on EGS outcomes stratifying patients according to surgical procedure risk.…”

mentioning

confidence: 99%

“…Inadequate access to EGS care is affected by many factors, including, but not limited to, heterogeneity in human and technical resource availability, current trends in the development and training of the surgical workforce, and patient complexity requiring care in highly specialized centers. These factors have led to an increased number of EGS patients requiring transfer to a higher level of care 5–8 …”

mentioning

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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Quality of Care for Gallstone Pancreatitis—the Impact of the Acute Care Surgery Model and Hospital-Level Operative Resources

Murphy

Oslock

Ingraham

et al. 2022

Journal of Gastrointestinal Surgery

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Impact of interhospital transfer on patient outcomes in emergency general surgery

Cited by 18 publications

References 16 publications

Implementation and outcomes of an urban mobile adult extracorporeal life support program

Implementation and outcomes of an urban mobile adult extracorporeal life support program

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

Quality of Care for Gallstone Pancreatitis—the Impact of the Acute Care Surgery Model and Hospital-Level Operative Resources

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