Factors associated with the interhospital transfer of emergency general surgery patients
Open accessAbstract
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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When guidelines are vague and transfer practices are varied, opportunities for structural and interpersonal discrimination can arise.
“Still, when guidelines are vague and transfer practices are varied, opportunities for structural and interpersonal discrimination can arise.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [12]
The Discussion says EGS transfer standards have not been established and anticipates variation in transfer rates among similar patients. It does not say that these conditions create opportunities for structural or interpersonal discrimination. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe selection of covariates was made a priori based on factors known to influence interhospital transfer.
“The selection of covariates was made a priori based on factors known to influence IHT.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [12]
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- Authors
- Ingraham, A., Wang, X., Havlena, J., Hanlon, B., Saucke, M., Schumacher, J., Fernandes-Taylor, S., & Greenberg, C.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Ingraham, Angela
- ORCID
- Venue
- Journal of Surgical Research
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 240
- Pages
- 191-200
- ISSN
- 0022-4804 (ISSN-L)
- PMC
- PMC7053531
- OpenAlex
- W2937548897
- Cited by
- 34
- References
- 31
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 9 · 2021: 3 · 2020: 6
- FWCI
- 5.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Surgical Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (1K08HS025224-01A1)
- Clinical and Translational Science Award (CTSA) program
- National Institutes of Health (NIH) National Center for Advancing Translational Sciences (UL1TR002373)
- 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 factors, hospital size, teaching hospitals, rural hospitals, public hospitals, biliary surgery, upper gastrointestinal surgery, patient vulnerability, competing risks
- MeSH terms
- Adult, Age Factors, Decision Making, Organizational, Emergency Service, Hospital, Female, Medicare, Hospitals, Humans, Male, Medicaid, Middle Aged, Patient Transfer, Retrospective Studies, Risk Factors, Surgical Procedures, Operative, United States, Insurance Coverage, Quality Improvement
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