Emergency general surgery transfers in the United States: a 10-year analysis
Abstract
Background Emergency general surgery (EGS) admissions account for more than three million hospitalizations in the US annually; and interhospital transfers (IHTs) are costly. We aimed to better understand the population of transferred EGS patients and their subsequent care in a nationally representative sample.Methods Using the 2002-2011 Nationwide Inpatient Sample, we identified patients aged ≥18 years with an EGS noncardiovascular principal diagnosis who were transferred from another hospital with urgent or emergent admission status. Patient demographics, hospitalization characteristics, rates of operation, and mortality were identified. Procedure codes were classified into surgery and procedures based on the HCUP Surgery Flag.Results We identified an estimated 525,913 EGS admissions transferred from another acute care hospital. The mean age was 60 years, 51% were female, and >50% were Medicare patients. The rate of EGS IHTs increased while mortality decreased. Surgery was required for only 33% of transferred patients. The most common surgeries were laparoscopic cholecystectomy, lysis of adhesions, and wound debridement. The median length of stay was 4.4 days, 92% of patients were cared for in urban hospitals, and >50% in teaching hospitals.Conclusions The percent of patients with an EGS diagnosis requiring IHT is increasing, which may reflect a trend toward regionalization of EGS. Transfers require significant resources and may delay care. More than half of the EGS patients did not require surgical intervention. Future studies to identify populations who benefit from IHT and ideal timing of transfer can establish opportunities for optimizing resource utilization and patient outcomes.
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- Authors
- Reinke, C. E., Thomason, M., Paton, L., Schiffern, L., Rozario, N., & Matthews, B. D.
- Affiliations
- Carolinas Medical Center (US)
- Carolinas Healthcare System (US)
- Corresponding author
- Reinke, Caroline E.
- Venue
- Journal of Surgical Research
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 219
- Pages
- 128-135
- ISSN
- 0022-4804 (ISSN-L)
- OpenAlex
- W2726048282
- Cited by
- 51
- References
- 25
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 15 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 3
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Surgical Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- emergency general surgery, interhospital transfer, hospital readmission, regionalization of care, postoperative mortality, length of hospital stay, teaching hospitals, Medicare beneficiaries, laparoscopic cholecystectomy, adhesiolysis, wound debridement, resource utilization (health care)
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Emergency Medical Services, Female, Humans, Inpatients, Male, Middle Aged, Patient Transfer, General Surgery, United States, Young Adult
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