C. E. Reinke1, M. Thomason1, L. Paton1, L. Schiffern1, N. Rozario2, 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. Patients who require surgery after transfer utilize additional resources and have higher acuity and worse outcomes. We aim to better understand the population of all transferred EGS patients and their subsequent care in a nationally representative sample.
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) who were transferred from another hospital with urgent or emergent admission status. Patient demographics, hospitalization characteristics, rates of operation and mortality were identified. Procedure codes were classified into surgery (broad) and procedures (narrow) based on the HCUP Surgery Flag definition.
Results: From 2002-2011 there were an estimated 525,913 EGS admissions that were transferred from another hospital. The mean age was 60 years, 51% were female, and over half of patients were Medicare patients. Over 10 years, EGS transfers increased from 1.2% of EGS admissions to 3.0% (Figure 1). More than half of the admissions were due to a HPB, Upper GI, or intestinal obstruction principal diagnosis. A surgery or procedure required for less than half of patients and remained steady over the time period (range 42-47%). Surgery was required for 33% of patients and a procedure for 21% of patients. On average, there were 2.7 days from admission to first procedure. The most common surgeries were laparoscopic cholecystectomy, lysis of adhesions and wound debridement. The most common procedure was endoscopic sphincterotomy, endoscopic removal of bile stone and endoscopic control of gastric hemorrhage. The median length of stay was 4.4 days. Mortality was 4.0% in patients who did not have a procedure and 4.4% in those that did.
Conclusions: The percent of patients with an EGS diagnosis requiring interhospital transfer is on the rise, which may reflect a trend towards regionalization of EGS. Transfers require significant resources and may delay care. More than half of the EGS patients did not require surgical intervention. Future studies to identify populations who most benefit from interhospital transfer and ideal timing of transfer can identify opportunities for optimizing resource utilization and patient outcomes.
