06.14 Racial and Sex Disparities with Interhospital Transfers for Emergency General Surgery Patients

Posted on April 24, 2024

H. Patel1, A. Elkbuli2  1Nova Southeastern University Dr. Kiran C Patel College of Allopathic Medicine, Davie, FLORIDA, USA 2Orlando Regional Medical Center, Orlando, FL, USA

Introduction:
Studies focusing on Emergency General Surgery (EGS) and Interhospital Transfer (IHT) and the effect of race and sex on morbidity and mortality have yet to be conducted. We aim to investigate the effects of race and sex on outcomes among interhospital transfer patients who underwent emergency general surgery.

Methods:
A retrospective review of adult patients who were transferred prior to EGS procedures using the National Surgery Quality Improvement Project from 2014 to 2020. Multivariable logistic regression models were used to compare outcomes (readmission, major and minor postoperative complications, and reoperation) between interhospital transfer and direct admit patients, and to investigate the association of race and sex for adverse outcomes for all EGS procedures. A secondary analysis was performed for each individual EGS procedure.

Results:
Compared to patients transferred directly from home, IHT patients (n = 28,517) had higher odds of readmission [OR: 1.004, 95% CI (1.002-1.006), p<0.001], major complication [AOR: 1.119, 95% CI (1.117-1.121), p<0.001), minor complication [OR: 1.078, 95% CI (1.075-1.080), p<0.001], and reoperation [OR: 1.014, 95% CI (1.013-1.015), p<0.001]. In all EGS procedures, Black patients had greater odds of minor complication [OR 1.041, 95% CI (1.023-1.060), p<0.001], Native Hawaiian and Pacific Islander patients had greater odds of readmission [OR 1.081, 95% CI (1.008-1.160), p=0.030], while Asian and Hispanic patients were at lower risk for adverse outcome, and female patients had greater odds of minor complication [OR 1.017, 95% CI (1.008-1.027), p<0.001]. 

Conclusion:
Procedure-specific racial and sex-related disparities exist in emergency general surgery patients who underwent interhospital transfer. Specific interventions should be implemented to address these disparities to improve the safety of emergency procedures.