Improvements Needed for Selection of Transfer Destinations for Emergency General Surgery

Larger hospitals are associated with more resources for emergency general surgery patients.

Opportunities exist to improve the selection of transfer destinations for patients with emergency general surgery conditions.

The findings of the recent study suggested optimizing transfer destination in the interhospital transfer network may improve such outcomes.

Cindy Y. Teng, M.D., and a team of Pittsburgh-based investigators examined whether patients with emergency surgery conditions were consistently directed to hospitals with more resources and better outcomes. The team analyzed interhospital transfers among adults with emergency general surgery conditions from January 1 to December 31, 2016. They used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in eight states.

More than 700 hospitals were included in the study. Eligible participants were at least 18 years old and had an acute care hospital encounter with a diagnosis of an emergency general surgery condition.

The primary outcome was hospital-level centrality ratio — the normalized number of incoming transfers divided by the number of outgoing transfers. If the ratio was higher, it meant there were more incoming transfers per outgoing transfer. The team hypothesized higher hospitality centrality ratio was associated with more resources, higher volume, and better outcomes.

There were more than 80,000 patients analyzed, of whom, the median age was 63 years old, 52.1% were male, and 78.8% were White. The median number of outgoing transfers per hospital was 106, while incoming transfers was 36.

As the investigators hypothesized, a higher log-transformed centrality was associated with more resources like higher ICU capacity and higher emergency general surgery volume. But such a ratio was not linked with better outcomes, such as lower in-hospital mortality and lower failure to rescue — the occurrence of a complication followed by in-hospital death for emergency general surgery episodes that involved an operation or procedure.

Hospitals with a higher ICU capacity, higher volume, and higher-quality trauma care were associated with better emergency general surgery outcomes.

The findings emphasized the need for further research into the appropriate selection of transfer destinations as a strategy to improve emergency general surgery outcomes.

“Our results raise questions about whether [emergency general surgery] transfers are consistently directed to appropriate hospitals for further care and new concerns regarding how we determine appropriate hospitals in the absence of standardized guidelines,” Teng and the team wrote.

The study, “Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions,” was published online in JAMA Network Open.