Interhospital transfer and adverse outcomes after general surgery: implications for pay for performance

Area of Science:

• General Surgery
• Health Services Research

Background:

• Interhospital transfer is a frequent occurrence in healthcare.
• Transferred patients often exhibit poorer health outcomes compared to direct admissions.

Purpose of the Study:

• To determine the incidence of interhospital transfer in general surgery.
• To evaluate the association between interhospital transfer and surgical outcomes.

Main Methods:

• Utilized the 2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
• Compared transferred patients with urgent, inpatient direct admissions.
• Employed risk-adjustment models, including multiple regression and propensity score matching.

Main Results:

• Approximately 7% of inpatient general surgery cases involved interhospital transfer.
• Unadjusted analysis revealed higher complication and mortality risks for transferred patients.
• After risk adjustment and propensity score matching, outcomes for transferred patients were only modestly higher or equivalent to direct admissions.

Conclusions:

• Worse outcomes in transferred patients are primarily attributed to confounding patient characteristics, not the transfer process itself.
• Pay-for-performance initiatives should account for transfer status to ensure fair evaluation of hospitals accepting transfers.