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Does Hospital Transfer Impact Outcomes After Colorectal Surgery?

Does Hospital Transfer Impact Outcomes After Colorectal Surgery?
Author Information (click to view)

Chow CJ, Gaertner WB, Jensen CC, Sklow B, Madoff RD, Kwaan MR,


Chow CJ, Gaertner WB, Jensen CC, Sklow B, Madoff RD, Kwaan MR, (click to view)

Chow CJ, Gaertner WB, Jensen CC, Sklow B, Madoff RD, Kwaan MR,

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Diseases of the colon and rectum 60(2) 194-201 doi 10.1097/DCR.0000000000000765
Abstract
BACKGROUND
With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion.

OBJECTIVE
We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables.

DESIGN
We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009-2013 American College of Surgeons National Surgical Quality Improvement Program database.

SETTINGS
The study was conducted at a tertiary care hospital.

PATIENTS
All of the patients who underwent colorectal surgery during the study period were included. Patients were excluded for unknown transfer status or transfer from a chronic care facility.

MAIN OUTCOME MEASURES
Baseline characteristics were compared by transfer status. Multivariate logistic regression was used to evaluate the impact of transfer on major complications and mortality.

RESULTS
A total of 7259 operations (4.6%) were performed after transfer. Transferred patients had higher rates of complications (p < 0.0001) with significant differences in unplanned endotracheal reintubation, bleeding, organ-space surgical site infection, wound dehiscence, postoperative sepsis, cardiac arrest requiring cardiopulmonary resuscitation, deep venous thrombosis, and myocardial infarction. Transferred patients also had longer hospital stays (9 vs 6 days; p < 0.0001) and a higher risk of death (13.2% vs 2.6%; p < 0.0001). On multivariate analysis, transferred patients had higher mortality rates despite risk adjustment (OR = 1.13 (95% CI, 1.02-1.25); p = 0.019) and were also more likely to have serious complications (OR = 1.12 (95% CI, 1.06-1.19); p < 0.001). LIMITATIONS
We were unable to analyze outcomes beyond 30 days, and we did not have information on preoperative evaluation or the reason for patient transfer.

CONCLUSIONS
Hospital-to-hospital transfer independently contributed to patient morbidity and mortality in patients undergoing colorectal surgery. The impact of hospital transfer must be considered when evaluating surgeon and hospital performance, because the increased risk of serious complications or death is not fully accounted for by traditional methods.

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