Tags

Type your tag names separated by a space and hit enter

Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis.
J Am Coll Surg. 2022 05 01; 234(5):737-746.JA

Abstract

BACKGROUND

Patients undergoing emergency general surgery (EGS) and interhospital transfer (IHT) have increased mortality. Prior analyses of IHT have been limited by the inability to track post-discharge outcomes or have not included nonoperative EGS. We evaluated outcomes for IHT to our tertiary care facility compared with direct admission through the emergency department.

STUDY DESIGN

Patients admitted directly (2015 to 2017) with a common EGS diagnosis (appendicitis, cholecystitis, choledocholithiasis, small bowel obstruction, and diverticulitis) were propensity score matched to patients transferred from another acute care hospital. Propensity score matching (PSM) was performed using patient characteristics, EGS diagnosis, comorbidities, and surgical critical care consultation. The primary outcome was inpatient mortality, and secondary outcomes were length of stay (LOS) 30-day hospital readmission.

RESULTS

We identified 3,153 directly admitted patients and 1,272 IHT patients. IHT patients were older (mean 59.4 vs 51.5 years), had a higher Charlson comorbidity index (median 3 vs 1), White race (72% vs 49%), and BMI greater than 40 kg/m2 (11.6% vs 9.8%). After PSM, each group included 1,033 patients. IHT patients had a higher median LOS (5.5 days vs 3.8, p < 0.001), higher inpatient mortality (odds ratio [OR] 1.69, p = 0.03), and more complications (OR 1.57, p < 0.001). The rate of post-discharge 30-day hospital encounters was similar (OR 1.08, p = 0.460). However, IHT patients had more emergency department encounters (OR 1.35, p = 0.04) and fewer observation-status readmissions (OR 0.53, p = 0.01).

CONCLUSIONS

After PSM to reduce confounding variables, patients with common EGS diagnoses transferred to a tertiary care facility have increased inpatient morbidity and mortality. The increased morbidity and resource utilization for these patients extends beyond the index hospital stay.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Watson M
From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Watson, Schiffern, Ross, Matthews, Reinke).
Zhao J
the Center for Outcomes Research & Evaluation, Atrium Health, Charlotte, NC (Zhao, Turk, Hetherington).
Turk P
the Center for Outcomes Research & Evaluation, Atrium Health, Charlotte, NC (Zhao, Turk, Hetherington).
Hetherington T
the Center for Outcomes Research & Evaluation, Atrium Health, Charlotte, NC (Zhao, Turk, Hetherington).
Schiffern L
From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Watson, Schiffern, Ross, Matthews, Reinke).
Ross SW
From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Watson, Schiffern, Ross, Matthews, Reinke).
Matthews BD
From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Watson, Schiffern, Ross, Matthews, Reinke).
Reinke CE
From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Watson, Schiffern, Ross, Matthews, Reinke).

MeSH

AftercareEmergency Service, HospitalGeneral SurgeryHospital MortalityHumansInpatientsLength of StayPatient DischargePatient TransferPropensity ScoreRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35426384

Citation

Watson, Michael, et al. "Emergency General Surgery Transfer and Effect On Inpatient Mortality and Post-Discharge Emergency Department Visits: a Propensity Score Matched Analysis." Journal of the American College of Surgeons, vol. 234, no. 5, 2022, pp. 737-746.
Watson M, Zhao J, Turk P, et al. Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis. J Am Coll Surg. 2022;234(5):737-746.
Watson, M., Zhao, J., Turk, P., Hetherington, T., Schiffern, L., Ross, S. W., Matthews, B. D., & Reinke, C. E. (2022). Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis. Journal of the American College of Surgeons, 234(5), 737-746. https://doi.org/10.1097/XCS.0000000000000146
Watson M, et al. Emergency General Surgery Transfer and Effect On Inpatient Mortality and Post-Discharge Emergency Department Visits: a Propensity Score Matched Analysis. J Am Coll Surg. 2022 05 1;234(5):737-746. PubMed PMID: 35426384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency General Surgery Transfer and Effect on Inpatient Mortality and Post-Discharge Emergency Department Visits: A Propensity Score Matched Analysis. AU - Watson,Michael, AU - Zhao,Jing, AU - Turk,Philip, AU - Hetherington,Timothy, AU - Schiffern,Lynnette, AU - Ross,Samuel W, AU - Matthews,Brent D, AU - Reinke,Caroline E, PY - 2022/4/15/entrez PY - 2022/4/16/pubmed PY - 2022/4/19/medline SP - 737 EP - 746 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 234 IS - 5 N2 - BACKGROUND: Patients undergoing emergency general surgery (EGS) and interhospital transfer (IHT) have increased mortality. Prior analyses of IHT have been limited by the inability to track post-discharge outcomes or have not included nonoperative EGS. We evaluated outcomes for IHT to our tertiary care facility compared with direct admission through the emergency department. STUDY DESIGN: Patients admitted directly (2015 to 2017) with a common EGS diagnosis (appendicitis, cholecystitis, choledocholithiasis, small bowel obstruction, and diverticulitis) were propensity score matched to patients transferred from another acute care hospital. Propensity score matching (PSM) was performed using patient characteristics, EGS diagnosis, comorbidities, and surgical critical care consultation. The primary outcome was inpatient mortality, and secondary outcomes were length of stay (LOS) 30-day hospital readmission. RESULTS: We identified 3,153 directly admitted patients and 1,272 IHT patients. IHT patients were older (mean 59.4 vs 51.5 years), had a higher Charlson comorbidity index (median 3 vs 1), White race (72% vs 49%), and BMI greater than 40 kg/m2 (11.6% vs 9.8%). After PSM, each group included 1,033 patients. IHT patients had a higher median LOS (5.5 days vs 3.8, p < 0.001), higher inpatient mortality (odds ratio [OR] 1.69, p = 0.03), and more complications (OR 1.57, p < 0.001). The rate of post-discharge 30-day hospital encounters was similar (OR 1.08, p = 0.460). However, IHT patients had more emergency department encounters (OR 1.35, p = 0.04) and fewer observation-status readmissions (OR 0.53, p = 0.01). CONCLUSIONS: After PSM to reduce confounding variables, patients with common EGS diagnoses transferred to a tertiary care facility have increased inpatient morbidity and mortality. The increased morbidity and resource utilization for these patients extends beyond the index hospital stay. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/35426384/Emergency_General_Surgery_Transfer_and_Effect_on_Inpatient_Mortality_and_Post_Discharge_Emergency_Department_Visits:_A_Propensity_Score_Matched_Analysis_ DB - PRIME DP - Unbound Medicine ER -