M. Abiad1, E. Lagazzi1, W. Rafaqat1, D. Argandykov1, S. Arnold1, A. Hoekman1, V. Panossian1, C. Paranjape1, M. P. DeWane1, G. Velmahos1, J. O. Hwabejire1 1Massachusetts General Hospital, Trauma, Emergency Surgery, Surgical Critical Care, Boston, MA, USA
Introduction: Emergency general surgery (EGS) performed among patients aged >65 years represents a particularly high-risk population. Although interhospital transfer has been linked to higher mortality in EGS patients, its impact on outcomes in the geriatric population remains uncertain. This study aims to establish the effect of interhospital transfer on postoperative outcomes in geriatric EGS patients.
Methods: EGS patients aged 65 years and older were identified within the 2015-2017 ACS-NSQIP database. Patients were categorized based on admission source as either directly admitted or transferred from an outside facility. The primary outcomes evaluated were in-hospital mortality, 30-day mortality, and overall morbidity. Propensity score matching was used to control for confounders including age, race, comorbidities, and pre-operative conditions. Kaplan-Meier survival analysis and the log-rank test were used to compare 30-day survival in the matched cohort.
Results: Among the 50,846 patients identified, 7,684 (15.11%) were transfer patients. The median age was 74, and 53.2% were female. Transfer patients had higher rates of comorbidities and pre-operative conditions, including a higher prevalence of pre-operative sepsis (27.9% vs. 24.2%, p<0.001) and ventilator dependence (6.9% vs. 2.8%, p<0.001). After propensity score-matched analysis, transferred patients exhibited higher rates of in-hospital mortality, 30-day mortality, and overall morbidity. Transfer patients were also less likely to be discharged home, and more likely to be discharged to an acute care facility. Kaplan-Meier survival analysis confirmed a poorer 30-day survival in transferred patients.
Conclusion: Interhospital transfer independently contributed to overall mortality and morbidity amongst geriatric EGS patients. Further investigation into improved coordination between hospitals, tailored care plans, and comprehensive risk assessments are needed to help mitigate the observed differences in outcomes.
