Factors Associated With the Interhospital Transfer of Emergency General Surgery Patients.

Authors:
Angela Ingraham
Angela Ingraham
American College of Surgeons
United States
Xing Wang
Xing Wang
Tianjin Medical University General Hospital
China
Jeffrey Havlena
Jeffrey Havlena
University of Wisconsin-Madison
United States
Bret Hanlon
Bret Hanlon
University of Wisconsin-Madison
United States
Megan Saucke
Megan Saucke
University of Wisconsin School of Medicine and Public Health
Jessica Schumacher
Jessica Schumacher
University of Wisconsin School of Medicine and Public Health
Sara Fernandes-Taylor
Sara Fernandes-Taylor
University of Wisconsin School of Medicine and Public Health
United States
Caprice Greenberg
Caprice Greenberg
Brigham and Women's Hospital
United States

J Surg Res 2019 Aug 9;240:191-200. Epub 2019 Apr 9.

Department of Surgery, University of Wisconsin, Madison, Wisconsin.

Background: Transferred emergency general surgery (EGS) patients constitute a highly vulnerable, acutely ill population. Guidelines to facilitate timely, appropriate EGS transfers are lacking. We determined patient- and hospital-level factors associated with interhospital EGS transfers, a critical first step to identifying which patients may require transfer.

Methods: Adult EGS patients (defined by American Association for the Surgery of Trauma International Classification of Diseases, Ninth Revision diagnosis codes) were identified within the 2008-2013 Nationwide Inpatient Sample (n = 17,175,450). Patient- and hospital-level factors were examined as predictors of transfer to another acute care hospital with a multivariate proportional cause-specific hazards model with a competing risk analysis to assess the effect of risk factors for transfer.

Results: 1.8% of encounters resulted in a transfer (n = 318,286). Transferred patients were on average 62 y old and most commonly had Medicare (52.9% [n = 168,363]), private (26.7% [n = 84,991]), or Medicaid insurance (10.8% [n = 34,279]). 67.7% were white. The most common EGS diagnoses among transferred patients were related to hepatic-pancreatic-biliary (n = 90,989 [28.6%]) and upper gastrointestinal tract (n = 60,088 [18.9%]) conditions. Most transferred patients (n = 269,976 [84.8%]) did not have a procedure before transfer. Transfer was more likely if patients were in small (hazard ratio 2.52, 95% confidence interval 2.28-2.79) or medium (1.32, 1.21-1.44) versus large facilities, government (1.19, 1.11-1.28) versus private facilities, and rural (4.58, 3.98-5.27) or urban nonteaching (1.89, 1.70-2.10) versus urban teaching facilities. Patient-level factors were not strong predictors of transfer.

Conclusions: We identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. Consideration of these factors by providers as care is delivered in the context of the resources and capabilities of local institutions may facilitate transfer decision-making.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S00224804183084
Publisher Site
http://dx.doi.org/10.1016/j.jss.2018.11.053DOI Listing
August 2019
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