Abstract
Background
Emergency general surgery (EGS) patients require surgical intervention and often critical care. Current literature suggests that interfacility transfer potentially face worse outcomes including increased mortality and complications. This study aims to evaluate patient transfers on mortality and the utilization of damage control laparotomy (DCL) in EGS.
Methods
Retrospective cohort study of patients undergoing emergent exploratory laparotomy at an academic institution from 2013 to 2023. Patients were included if they were ≥18 years old and underwent emergent nontraumatic laparotomy. Or primary outcome was mortality. Secondary outcomes included the usage of DCL, complications, intensive care unit admission, postoperative ventilation, and hospital length of stay.
Results
A total of 1249 patients were included with 745 (59.6%) direct admissions and 504 (40.4%) transfers. Transferred patients had higher PESAS scores (5 vs 3, P < 0.0001) and ASA classifications (ASA 4: 31% vs 22%, P = 0.0004). They also had higher rates of DCL (52% vs 42%, P = 0.0008), ICU admissions (52% vs 40%, P < 0.0001), and increased ventilation in transfers (47% vs 37%, P = 0.0004). While overall complications were higher in transferred patients (50% vs 39%, P = 0.0002), mortality rates were not significantly different (18% vs 14%, P = 0.1479).
Conclusions
Transferred EGS patients presented with greater preoperative severity and required DCL at higher rates. Transferred patients had increased complications, ICU, and ventilation needs. They also had an increase in complications however no difference in mortality. This suggests that while transferred patients are at increased preoperative acuity effective transfer systems and utilization of DCL may mitigate mortality risk in these patients.
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