Transfer Status: A Driver of Failure-to-Rescue in Emergency General Surgery

Abstract

Background

Emergency general surgery (EGS) patients who undergo interfacility transfer (IFT) experience higher rates of complications and mortality compared to those directly admitted (DA) to a hospital. However, their failure-to-rescue (FTR) rates—defined as mortality following a major complication—remain less studied. Given the increased burden of adverse outcomes in this population, we hypothesized that IFT patients would have higher risk-adjusted FTR rates than DA patients.

Methods

We performed a 5-year (2016-2020) retrospective analysis using the National Surgical Quality Improvement Program (NSQIP) database, focusing on patients aged 18 years and older undergoing high-risk EGS procedures, including enterectomy, colectomy, peptic ulcer surgery, and laparotomy. To assess the impact of IFT, we employed multivariable logistic regression models, adjusting for demographic factors, comorbidities, and procedure type.

Results

Among 70 028 patients (52% female, 66% white, median age 66), 15 032 (21.4%) underwent IFT. After risk adjustment, IFT patients demonstrated significantly higher odds of major complications (OR 1.09, 95% CI 1.04-1.14), mortality (OR 1.23, 95% CI 1.16-1.31), and FTR (OR 1.12, 95% CI 1.04-1.19), suggesting that transferred patients are at a distinct disadvantage compared to DA patients.

Discussion: Interfacility transfer is independently associated with worse outcomes in EGS patients, including higher FTR rates. These findings identify a vulnerable subpopulation of EGS patients that are readily identified by clinicians and highlights the need for future research to identify modifiable risk factors contributing to this disparity.