Identifying Futile Interfacility Surgical Transfers
The American Surgeon
|August 21, 2017
Summary
A small percentage of surgical transfers are futile, leading to death or hospice care within 72 hours without intervention. Identifying these futile transfers can reduce patient and family burdens.
Area of Science:
- Medical research
- Surgical outcomes
- Healthcare economics
Background:
- Surgeons suspect some interfacility surgical transfers are futile.
- The incidence and risk factors of futile transfers remain unquantified.
- Identifying futile transfers can reduce costs and patient/family burdens.
Purpose of the Study:
- To determine the incidence of futile interfacility surgical transfers.
- To identify risk factors associated with futile transfers.
- To inform strategies for improving patient care and resource allocation.
Main Methods:
- Retrospective cohort study (2009-2013).
- Included patients transferred for general or vascular surgical care to a tertiary referral center.
- Defined futile transfers as death or hospice discharge within 72 hours without intervention.
Main Results:
- 1% of patient transfers were futile (27/1696).
- Futile transfers were associated with older age, higher comorbidity, vascular surgery, Medicare insurance, and documented end-stage disease.
- Futile transfers had higher rates of do-not-resuscitate orders (82%) and palliative care consults (59%) compared to non-futile transfers.
Conclusions:
- A small but significant proportion of transfers are futile, involving care de-escalation and early death/hospice without intervention.
- Improved pre-transfer communication could identify at-risk patients, reducing burdens and facilitating deaths in local communities.
- This research highlights the need for better patient selection and communication in interfacility surgical transfers.
