Percentage of Mortal Encounters Transferred in Emergency General Surgery

Overview

Journal J Surg Res

Specialty General Surgery

Date 2019 Jul 6

PMID 31277017

Authors

Margaret H Lauerman

Anthony V Herrera

Jennifer S Albrecht

Hegang H Chen

Brandon R Bruns

Ronald B Tesoriero

Thomas M Scalea

Jose J Diaz

Affiliations

Soon will be listed here.

Abstract

Background: Despite the frequent occurrence of interhospital transfers in emergency general surgery (EGS), rates of transfer of complications are undescribed. Improved understanding of hospital transfer patterns has a multitude of implications, including quality measurement. The objective of this study was to describe individual hospital transfer rates of mortal encounters.

Materials And Methods: A retrospective review was undertaken from 2013 to 2015 of the Maryland Health Services Cost Review Commission database. Two groups of EGS encounters were identified: encounters with death following transfer and encounters with death without transfer. The percentage of mortal encounters transferred was defined as the percentage of EGS hospital encounters with mortality initially presenting to a hospital transferred to another hospital before death at the receiving hospital.

Results: Overall, 370,242 total EGS encounters were included, with 17,003 (4.6%) of the total EGS encounters with mortality. Encounters with death without transfer encompassed 15,604 (91.8%) of mortal EGS encounters and encounters with death following transfer 1399 (8.2%). EGS disease categories of esophageal varices or perforation, necrotizing fasciitis, enterocutaneous fistula, and pancreatitis had over 10% of these total mortal encounters with death following transfer. For individual hospitals, percentage of mortal encounters transferred ranged from 0.8% to 35.2%. The percentage of mortal encounters transferred was inversely correlated with annual EGS hospital volume for all state hospitals (P < 0.001, r = -0.57).

Conclusions: Broad variability in individual hospital practices exists for mortality transferred to other institutions. Application of this knowledge of percentage of mortal encounters transferred includes consideration in hospital quality metrics.

References

Kastor J, Adashi E . Maryland's hospital cost review commission at 40: a model for the country. JAMA. 2011; 306(10):1137-8. DOI: 10.1001/jama.2011.1311. View

Bilimoria K, Barnard C . The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned. JAMA. 2016; 316(17):1761-1762. DOI: 10.1001/jama.2016.13679. View

Ban K, Cohen M, Ko C, Friedberg M, Stulberg J, Zhou L . Evaluation of the ProPublica Surgeon Scorecard "Adjusted Complication Rate" Measure Specifications. Ann Surg. 2016; 264(4):566-74. DOI: 10.1097/SLA.0000000000001858. View

Bruns B, Tesoriero R, Narayan M, Klyushnenkova E, Chen H, Scalea T . Emergency General Surgery: Defining Burden of Disease in the State of Maryland. Am Surg. 2015; 81(8):829-34. View

Rosenberg A, Hofer T, Strachan C, Watts C, Hayward R . Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures. Ann Intern Med. 2003; 138(11):882-90. DOI: 10.7326/0003-4819-138-11-200306030-00009. View

Tyler P, Stone D, Geisler B, McLennan S, Celi L, Rush B . Racial and Geographic Disparities in Interhospital ICU Transfers. Crit Care Med. 2017; 46(1):e76-e80. PMC: 5743219. DOI: 10.1097/CCM.0000000000002776. View

Kindermann D, Mutter R, Houchens R, Barrett M, Pines J . Emergency department transfers and transfer relationships in United States hospitals. Acad Emerg Med. 2015; 22(2):157-65. DOI: 10.1111/acem.12586. View

Ogola G, Gale S, Haider A, Shafi S . The financial burden of emergency general surgery: National estimates 2010 to 2060. J Trauma Acute Care Surg. 2015; 79(3):444-8. DOI: 10.1097/TA.0000000000000787. View

Lucas D, Ejaz A, Haut E, Spolverato G, Haider A, Pawlik T . Interhospital transfer and adverse outcomes after general surgery: implications for pay for performance. J Am Coll Surg. 2014; 218(3):393-400. DOI: 10.1016/j.jamcollsurg.2013.11.024. View

10.

Combes A, Luyt C, Trouillet J, Chastre J, Gibert C . Adverse effect on a referral intensive care unit's performance of accepting patients transferred from another intensive care unit. Crit Care Med. 2005; 33(4):705-10. DOI: 10.1097/01.ccm.0000158518.32730.c5. View

11.

Shafi S, Aboutanos M, Agarwal Jr S, Brown C, Crandall M, Feliciano D . Emergency general surgery: definition and estimated burden of disease. J Trauma Acute Care Surg. 2013; 74(4):1092-7. DOI: 10.1097/TA.0b013e31827e1bc7. View

12.

Warren J, Fromm Jr R, Orr R, Rotello L, Horst H . Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004; 32(1):256-62. DOI: 10.1097/01.CCM.0000104917.39204.0A. View

13.

Santry H, Janjua S, Chang Y, Petrovick L, Velmahos G . Interhospital transfers of acute care surgery patients: should care for nontraumatic surgical emergencies be regionalized?. World J Surg. 2011; 35(12):2660-7. DOI: 10.1007/s00268-011-1292-3. View

14.

Narayan M, Tesoriero R, Bruns B, Klyushnenkova E, Chen H, Diaz J . Acute care surgery: defining mortality in emergency general surgery in the state of Maryland. J Am Coll Surg. 2015; 220(4):762-70. DOI: 10.1016/j.jamcollsurg.2014.12.051. View

15.

Iwashyna T, Christie J, Moody J, Kahn J, Asch D . The structure of critical care transfer networks. Med Care. 2009; 47(7):787-93. PMC: 2760433. DOI: 10.1097/MLR.0b013e318197b1f5. View