Interhospital transfers of acute care surgery patients: should care for nontraumatic surgical emergencies be regionalized?
Open accessAbstract
BACKGROUND: Patients with major nontraumatic surgical emergencies (NTSEs) are commonly transferred from small hospitals to tertiary care centers. We hypothesized that transferred patients (TRANS) have worse outcomes than patients with similar diagnoses admitted directly to a tertiary center (DIRECT). METHODS: We reviewed all patients admitted to the acute care surgery service of our tertiary center (September 1, 2006-October 31, 2009) with one of eight diagnoses indicating a major NTSE. Patients transferred for reasons other than the severity of illness were excluded. Univariate and multivariable analyses compared TRANS and DIRECT patients. RESULTS: Of 319 patients eligible for analysis, 103 (34%) were TRANS and averaged 3.8 days in the referring hospital before transfer. Compared to DIRECT patients, TRANS patients were more likely to be obese (18.5 vs. 8.0%, P = 0.006) and have cardiac (24 vs. 14%, P = 0.022) or pulmonary (25 vs. 12%, P = 0.003) co-morbidities. TRANS patients were also more likely to present to the tertiary center with hypotension (9 vs. 2%, P = 0.021), tachycardia (20 vs. 13%, P = 0.036), anemia (83 vs. 58%, P < 0.001), and hypoalbuminemia (50 vs. 14%, P < 0.001). TRANS patients had higher mortality (4.9 vs. 0.9%, P = 0.038) and longer hospital stay (8 with 5-13 days vs. 5 with 3-8 days, P < 0.001). CONCLUSIONS: TRANS patients comprised a significant portion of the population with major NTSEs admitted to the acute care surgery service of our tertiary center. They presented with greater physiologic derangement and had worse outcomes than DIRECT patients. As is currently established for trauma care, regionalization of care for NTSEs should be considered.
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- Authors
- Santry, H. P., Janjua, S., Chang, Y., Petrovick, L., & Velmahos, G. C.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- St. Elizabeth's Medical Center (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Santry, Heena P.
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2011-10-15
- Volume
- 35
- Issue
- 12
- Pages
- 2660-2667
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- OpenAlex
- W1987349325
- Cited by
- 61
- References
- 22
- Citations by year
- 2024: 2 · 2022: 10 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 5 · 2016: 6 · 2015: 9 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- World Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- Topics
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- interhospital transfer, regionalization of care, tertiary care hospital, acute care surgery, patient outcomes, mortality, length of hospital stay, anemia, hypoalbuminemia, obesity, comorbidities
- MeSH terms
- Critical Care, Emergency Medical Services, Female, Humans, Male, Middle Aged, Patient Transfer, Prospective Studies, Surgical Procedures, Operative
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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