Transferred Emergency General Surgery Patients Are at Increased Risk of Death
*Manuel Castillo-Angeles, *Tarsicio Uribe-Leitz, *Molly Jarman, *Timothy Feeney, Ali Salim, Joaquim M Havens
Brigham and Women's Hospital, Boston, MA
Objective: Emergency General Surgery (EGS) encompasses high risk patients undergoing high risk procedures. Admission source, particularly interhospital transfers, is rarely accounted for clinical performance benchmarking. Our goal was to assess the impact of transferred patients on outcomes following EGS.
Design: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database (2005-2014).
Setting: High-quality surgical outcomes data from more than 80 US hospitals participating in ACS NSQIP.
Patients: All inpatients that underwent one of 7 EGS procedures shown to represent 80% of EGS volume, complications, and mortality nationally.
Interventions: Admission source was classified as directly admitted versus transferred from an outside emergency room or an acute care facility.
Main Outcome Measures: The primary outcomes were overall mortality, overall morbidity and major morbidity.
Results: A total of 619,174 EGS admissions were identified, of which 31,173 (5%) were transfers. Mean age was 55.8 years and 52% were female. Overall mortality was 2.8% for the entire cohort and 10.1% within the transfer group. After risk adjustment for 33 clinical and demographic variables, transferred patients had higher rates of overall mortality (Odds Ratio [OR] 1.12, 95% Confidence Interval [CI] 1.05 - 1.21), higher overall morbidity (OR 1.28, 95% CI 1.22 - 1.34) and major morbidity (OR 1.29, 95% CI 1.21 - 1.37) when compared with directly admitted patients.
Conclusions: After rigorous risk adjustment, interhospital transfer status is an independent risk factor for mortality and morbidity in the EGS population. This increased burden on accepting institutions may have an impact on quality metrics and should be considered for benchmarking of clinical performance.
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