C. E. Reinke1, M. Thomason1, N. Rozario1, B. D. Matthews1 1Carolinas Medical Center,Department Of Surgery,Charlotte, NC, USA 2Carolinas Medical Center,Dickson Advanced Analytics,Charlotte, NC, USA
Introduction: Emergency general surgery (EGS) admissions account for more than 3 million hospitalizations in the US annually. Although EGS transfers who undergo surgery have been shown to have worse outcomes, EGS transfers who are managed non-operatively have not previously been studied. We aim to better understand the characteristics and risk of mortality for EGS interhospital transfer (IHT) patients compared to EGS admissions from the Emergency Department (ED).
Methods: Using the 2002-2011 Nationwide Inpatient Sample we identified patients age ≥18 years with an EGS non-cardiovascular principal diagnosis (AAST EGS DRG ICD-9 codes) and urgent or emergent admission status. These patients were classified into IHT patients and ED patients based on admission source. Patient demographics, hospitalization characteristics, rates of operation and mortality were identified and compared between the two groups. The risk of mortality was calculated for IHT patients compared to ED patients, both before and after adjusting for patient characteristics in a multivariable analysis.
Results: From 2002-2011 there were an estimated 25,629,352 EGS admissions, 2% of which were IHTs. The mean age was 59 years, 54% were female, and 46% were Medicare patients. Transfer patients were more likely to be white, to be female, have Medicare. IHTs had higher rates of most comorbidities with the exception of AIDS, blood loss anemia, coagulation deficiency, and drug abuse. Upper gastrointestinal tract and hepatobiliary diagnosis categories were the most common EGS diagnosis in both groups, but a higher percentage of ED admissions had colorectal, general abdominal, or soft tissues diagnoses compared to IHTs. IHTs were more likely to undergo a surgery or procedure and had a higher mortality rate. The odds of mortality were increased for IHTs, and remained elevated even after controlling for patient characteristics and EGS diagnosis (Table 1).
Conclusions: EGS patients who are transferred from another acute care hospital are at higher risk of mortality even after controlling for a wide range of patient characteristics. They also undergo procedures and surgeries at a higher rate than ED patients. Future studies to identify other contributing factors to this increased risk can identify opportunities for decreasing the mortality rate in EGS transfers.
