Predicting Outcomes for Interhospital Transferred Patients of Emergency General Surgery

Abstract

Background. Interhospital transferred (IHT) emergency general surgery (EGS) patients are associated with high care intensity and mortality. However, prior studies do not focus on patient-level data. Our study, using each IHT patient’s data, aimed to understand the underlying cause for IHT EGS patients’ outcomes. We hypothesized that transfer origin of EGS patients impacts outcomes due to critical illness as indicated by higher Sequential Organ Failure Assessment (SOFA) score and disease severity. Materials and Methods. We conducted a retrospective analysis of all adult patients transferred to our quaternary academic center’s EGS service from 01/2014 to 12/2016. Only patients transferred to our hospital with EGS service as the primary service were eligible. We used multivariable logistic regression and probit analysis to measure the association of patients’ clinical factors and their outcomes (mortality and survivors’ hospital length of stay [HLOS]). Results. We analyzed 708 patients, 280 (39%) from an ICU, 175 (25%) from an ED, and 253 (36%) from a surgical ward. Compared to ED patients, patients transferred from the ICU had higher mean (SD) SOFA score (5.7 (4.5) vs. 2.39 (2), $P<0.001$ ), longer HLOS, and higher mortality. Transferring from ICU (OR 2.95, 95% CI 1.36–6.41, $P=0.006$ ), requiring laparotomy (OR 1.96, 95% CI 1.04–3.70, $P=0.039$ ), and SOFA score (OR 1.22, 95% CI 1.13–1.32, $P<0.001$ ) were associated with higher mortality. Conclusions. At our academic center, patients transferred from an ICU were more critically ill and had longer HLOS and higher mortality. We identified SOFA score and a few conditions and diagnoses as associated with patients’ outcomes. Further studies are needed to confirm our observation.