Open AccessImpact of Inter‐Hospital Transfer on Outcomes in Patients Undergoing Emergency Abdominal Surgery: A Tertiary Referral Center's Perspective
Author(s) -
Lavanchy Joël L.,
Dubuis JeanBaptiste,
Osterwalder Alice,
Winterhalder Sebastian,
Haltmeier Tobias,
Candinas Daniel,
Schnüriger Beat
Publication year - 2021
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/s00268-021-06174-5
Subject(s) - medicine , abdominal surgery , surgery , perforation , vascular surgery , cardiothoracic surgery , tertiary referral hospital , retrospective cohort study , cardiac surgery , materials science , punching , metallurgy
Abstract Background In trauma patients, the impact of inter‐hospital transfer has been widely studied. However, for patients undergoing emergency abdominal surgery (EAS), the effect of inter‐hospital transfer on outcomes is largely unknown. Methods This is a single‐center, retrospective observational study. Outcomes of transferred patients undergoing EAS were compared to patients primarily admitted to a tertiary care hospital from 01/2016 to 12/2018 using univariable and multivariable analyses. The primary outcome was in‐hospital mortality. Results Some 973 patients with a median (IQR) age of 58.1 (39.4–72.2) years and a median body mass index of 25.8 (22.5–29.3) kg/m 2 were included. The transfer group comprised 258 (26.3%) individuals and the non‐transfer group 715 (72.7%). The population was stratified in three subgroups: (1) patients with low surgical stress ( n = 483, 49.6%), (2) with hollow viscus perforation ( n = 188, 19.3%) and (3) with potential bowel ischemia ( n = 302, 31.1%). Neither in the low surgical stress nor in the hollow viscus perforation group was the transfer status associated with mortality. However, in the potential bowel ischemia group inter‐hospital transfer was a predictor for mortality (OR 3.54, 95%CI 1.03–12.12, p = 0.045). Moreover, in the hollow viscus perforation group inter‐hospital transfer was a predictor for reduced hospital length of stay (RC ‐10.02, 95%CI −18.14/−1.90, p = 0.016) and reduced severe complications (OR 0.38, 95%CI 0.18–0.77, p = 0.008). Conclusion Other than in patients with low surgical stress or hollow viscus perforation, in patients with potential bowel ischemia inter‐hospital transfer was an independent predictor for higher mortality. Taking into account the time sensitiveness of bowel ischemia, efforts should be made to avoid inter‐hospital transfer in this vulnerable subgroup of patients.