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.
Dr Christopher Chow and colleagues hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables.
The researchers 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.
The team conducted the study at a tertiary care hospital.
|Transferred patients had higher mortality rates despite risk adjustment|
|Diseases of the Colon & Rectum|
All of the patients who underwent colorectal surgery during the study period were included.
The research team excluded patients for unknown transfer status or transfer from a chronic care facility.
Baseline characteristics were compared by transfer status.
The team performed a total of 7259 operations after transfer.
Transferred patients had higher rates of complications 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.
The team also found that transferred patients also had longer hospital stays, and a higher risk of death.
The researchers noted that transferred patients had higher mortality rates despite risk adjustment, and were also more likely to have serious complications.
Dr Chow's team concluded, "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."