Interhospital transfer for emergency general surgery: An independent predictor of mortality

Am J Surg. 2018 Oct;216(4):787-792. doi: 10.1016/j.amjsurg.2018.07.055. Epub 2018 Aug 15.

Abstract

Background: Emergency general surgery (EGS) admissions account for more than 3 million hospitalizations in the US annually. We aim to better understand characteristics and mortality risk for EGS interhospital transfer patients compared to EGS direct admissions.

Methods: Using the 2002-2011 Nationwide Inpatient Sample we identified patients aged ≥18 years with an EGS admission. Patient demographics, hospitalization characteristics, rates of operation and mortality were compared between patients with interhospital transfer versus direct admissions.

Results: Interhospital transfers comprised 2% of EGS admissions. Interhospital transfers were more likely to be white, male, Medicare insured, and had higher rates of comorbidities. Interhospital transfers underwent more procedures/surgeries and had a higher mortality rate. Mortality remained elevated after controlling for patient characteristics.

Conclusions: Interhospital transfers are at higher risk of mortality and undergo procedures/surgeries more frequently than direct admissions. Identification of contributing factors to this increased mortality may identify opportunities for decreasing mortality rate in EGS transfers.

Keywords: Emergency general surgery; Interhospital transfer; Mortality; Regionalization.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Emergencies
  • Female
  • General Surgery
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Admission
  • Patient Transfer*
  • Risk Factors
  • Surgical Procedures, Operative / mortality*
  • United States / epidemiology
  • Young Adult