Factors associated with potentially avoidable interhospital transfers in emergency general surgery—a call for quality improvement efforts
Open accessAbstract
Background Emergency general surgery conditions are common, require urgent surgical evaluation, and are associated with high mortality and costs. Although appropriate interhospital transfers are critical to successful emergency general surgery care, the performance of emergency general surgery transfer systems remains unclear. We aimed to describe emergency general surgery transfer patterns and identify factors associated with potentially avoidable transfers.Methods We performed a retrospective cohort study of emergency general surgery episodes in 8 US states using the 2016 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases and the American Hospital Association Annual Surveys. We identified Emergency Department-to-Inpatient and Inpatient-to-Inpatient interhospital emergency general surgery transfers. Potentially avoidable transfers were defined as discharge within 72 hours after transfer without undergoing any procedure or operation at the destination hospital. We examined transfer incidence and characteristics. We performed multilevel regression examining patient-level and hospital-level factors associated with potentially avoidable transfers.Results Of 514,410 adult emergency general surgery episodes, 26,281 (5.1%) involved interhospital transfers (Emergency Department-to-Inpatient: 65.0%, Inpatient-to-Inpatient: 35.1%). Over 1 in 4 transfers were potentially avoidable (7,188, 27.4%), with the majority occurring from the emergency department. Factors associated with increased odds of potentially avoidable transfers included self-pay (versus government insurance, odds ratio: 1.26, 95% confidence interval: 1.09-1.45, P = .002), level 1 trauma centers (versus non-trauma centers, odds ratio: 1.24, 95% confidence interval: 1.05-1.47, P = .01), and critical access hospitals (versus non-critical access, odds ratio: 1.30, 95% confidence interval: 1.15-1.47, P < .001). Hospital-level factors (size, trauma center, ownership, critical access, location) accounted for 36.1% of potentially avoidable transfers variability.Conclusion Over 1 in 4 emergency general surgery transfers are potentially avoidable. Understanding factors associated with potentially avoidable transfers can guide research, quality improvement, and infrastructure development to optimize emergency general surgery care.
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- Authors
- Teng, C. Y., Davis, B. S., Kahn, J. M., Rosengart, M. R., & Brown, J. B.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Teng, Cindy Y.
- Venue
- Surgery
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 170
- Issue
- 5
- Pages
- 1298-1307
- ISSN
- 0039-6060 (ISSN-L)
- PMC
- PMC8550996
- OpenAlex
- W3175418524
- Cited by
- 26
- References
- 44
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 1
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-08-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Surgery (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (T32HL007820)
- National Heart, Lung, and Blood Institute (R35HL144804)
- 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
- interhospital transfer, emergency general surgery, self-pay, trauma centers, critical access hospitals, hospital ownership, hospital size, quality improvement, transfer patterns
- MeSH terms
- Aged, Emergencies, Emergency Service, Hospital, Emergency Treatment, Female, Humans, Inpatients, Male, Middle Aged, Patient Transfer, Retrospective Studies, United States, Cohort Studies, Incidence, Quality Improvement
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