Authors: Heena P Santry Sumbal Janjua Yuchiao Chang Laurie Petrovick George C Velmahos
Publish Date: 2011/10/15
Volume: 35, Issue: 12, Pages: 2660-2667
Abstract
Patients with major nontraumatic surgical emergencies NTSEs are commonly transferred from small hospitals to tertiary care centers We hypothesized that transferred patients TRANS have worse outcomes than patients with similar diagnoses admitted directly to a tertiary center DIRECTWe reviewed all patients admitted to the acute care surgery service of our tertiary center September 1 2006–October 31 2009 with one of eight diagnoses indicating a major NTSE Patients transferred for reasons other than the severity of illness were excluded Univariate and multivariable analyses compared TRANS and DIRECT patientsOf 319 patients eligible for analysis 103 34 were TRANS and averaged 38 days in the referring hospital before transfer Compared to DIRECT patients TRANS patients were more likely to be obese 185 vs 80 P = 0006 and have cardiac 24 vs 14 P = 0022 or pulmonary 25 vs 12 P = 0003 comorbidities TRANS patients were also more likely to present to the tertiary center with hypotension 9 vs 2 P = 0021 tachycardia 20 vs 13 P = 0036 anemia 83 vs 58 P 0001 and hypoalbuminemia 50 vs 14 P 0001 TRANS patients had higher mortality 49 vs 09 P = 0038 and longer hospital stay 8 with 5–13 days vs 5 with 3–8 days P 0001TRANS patients comprised a significant portion of the population with major NTSEs admitted to the acute care surgery service of our tertiary center They presented with greater physiologic derangement and had worse outcomes than DIRECT patients As is currently established for trauma care regionalization of care for NTSEs should be considered
Keywords: