Open AccessImpact of Interhospital Transfer on Outcomes in Non‐emergency Colorectal Surgery
Author(s) -
Sharp Stephen P.,
Schuster Daniel J.,
Ata Ashar,
Valerian Brian T.,
Canete Jonathan J.,
Chismark A. David,
Lee Edward C.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-017-4313-z
Subject(s) - medicine , abdominal surgery , colorectal surgery , vascular surgery , cardiac surgery , complication , surgery , rectum , emergency medicine
Abstract Background A paucity of data exists on the impact of transfer status on outcomes for patients undergoing non‐emergency (urgent) colorectal surgery. This study characterized transferred patients undergoing urgent colorectal surgery and determined which patient comorbidities significantly contributed to poor outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2013 was used. Urgent direct admissions undergoing colon, rectum, or small bowel operations were compared to urgent transfers using bivariate and multivariable analysis models. Primary outcomes were overall complications, hospital length of stay, and mortality. Results A total of 82,151 admissions were analyzed. After multivariable analysis, direct admission patients had nearly similar risk of complications (RR = 0.95; 95% CI 0.91–0.99) and length of hospital stay (7% shorter; 95% CI 4–9%), as well as no difference in mortality (RR = 0.94; 95% CI 0.80–1.11). Conclusions Transfer status alone confers minimal risk toward higher complication rates and longer hospital length of stay in patients undergoing urgent colorectal surgery, and the poor outcomes observed in this cohort are largely due to patient comorbidities and disease severity. Our results suggest that outcomes in transferred colorectal surgery patients undergoing urgent operations depend mainly on operative acuity and clinical factors, and to a lesser degree transfer status.