IP243. Emergency Vascular Surgery in Transfer Patients Is Associated With Greater Morbidity and Mortality Compared With Patients Presenting Directly From Home

Abstract

Objective: Emergent vascular surgery is often performed in patients transferred from one hospital to another for definitive surgical care; however, outcomes in this population have not been reported. In this study, we compared morbidity and mortality in patients presenting for emergent vascular surgery in the transferred and nontransferred populations.Methods: A retrospective analysis of prospectively collected data was performed using the National Surgical Quality Improvement Program database for all nonelective, emergent vascular surgery procedures performed between 2011 and 2014. Demographics, comorbidities, and 30-day complications and outcomes were compared between patients presenting from home and those presenting from another hospital or nursing home. Multivariate analysis was performed to determine the association between mode of presentation and major complications.Results: There were 14,831 patients identified; 9060 (61%) presented from home, and 5771 (39%) presented as a transfer from another hospital or a nursing home. Patients presenting in transfer were older (70 vs 67 years; P < .001), less likely to be diabetic (24% vs 30.2%; P < .001) or to be dialysis dependent (6.1% vs 9%; P < .001), and more likely to smoke (36.9% vs 32.5%; P < .001) or to have chronic obstructive pulmonary disease (16.7% vs 12%; P < .001). There was no difference in history of congestive heart failure (5.8% vs 5.7%; P ¼ .82). Patients presenting for surgery in transfer had increased rates of postoperative morbidity including pulmonary complications (22.0% vs 13.5%; P < .001), stroke (2.7% vs 1.8%; P < .001), urinary tract infection (3.9% vs 2.8%; P < .001), and bleeding requiring transfusion (48.1% vs 33.9%; P < .001). Mortality in the transfer group was significantly increased (15.6% vs 10.4%; P < .001). These differences persisted in multivariate analysis (Table ).Conclusions: Patients transferred from an outside hospital or nursing home who present for emergent vascular procedures demonstrate increased morbidity and mortality compared with those who present from home directly to the emergency department despite fewer comorbid conditions. Further study of transfer protocols and establishing guidelines for best practice in emergency vascular surgery are needed to improve outcomes for this population.