Impact of Inter-Hospital Transfer on Outcomes in Patients Undergoing Emergency Abdominal Surgery: A Tertiary Referral Center’s Perspective

• Published in: World journal of surgery 2021-09, Vol.45 (9), p.2703-2711
• Main Authors: Lavanchy, Joël L., Dubuis, Jean-Baptiste, Osterwalder, Alice, Winterhalder, Sebastian, Haltmeier, Tobias, Candinas, Daniel, Schnüriger, Beat
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Abdominal Surgery; Aged; Body mass; Body mass index; Body size; Cardiac Surgery; Complications; Emergency medical services; General Surgery; Hospital Mortality; Humans; Intestine; Ischemia; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Scientific Report; Patient Transfer; Patients; Retrospective Studies; Stress; Subgroups; Surgery; Tertiary Care Centers; Thoracic Surgery; Trauma; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-021-06174-5

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.