Does Hospital Transfer Impact Outcomes After Colorectal Surgery?

Area of Science:

• Surgical outcomes research
• Health services research
• Patient safety

Background:

• Public reporting of outcomes and bundled payments increase scrutiny of hospital performance.
• The impact of pre-operative patient transfer on colorectal surgery outcomes is not well understood in a risk-adjusted manner.

Purpose of the Study:

• To test the hypothesis that hospital-to-hospital transfer independently predicts morbidity and mortality in patients undergoing colorectal surgery.
• To evaluate the impact of transfer on patient outcomes beyond traditional risk factors.

Main Methods:

• Retrospective cohort study of 158,446 patients undergoing colorectal surgery (2009-2013).
• Data sourced from the American College of Surgeons National Surgical Quality Improvement Program database.
• Multivariate logistic regression used to assess the effect of transfer on major complications and mortality.

Main Results:

• Transferred patients (4.6% of cohort) experienced higher complication rates (p < 0.0001) and longer hospital stays (9 vs 6 days; p < 0.0001).
• Mortality risk was significantly higher in transferred patients (13.2% vs 2.6%; p < 0.0001).
• Multivariate analysis confirmed transfer as an independent predictor of higher mortality (OR = 1.13) and serious complications (OR = 1.12).

Conclusions:

• Hospital-to-hospital transfer is an independent risk factor for increased morbidity and mortality following colorectal surgery.
• Current performance evaluation methods may not fully account for the increased risks associated with patient transfer.
• Consideration of transfer status is crucial for accurate assessment of surgeon and hospital performance.