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Identifying Futile Interfacility Surgical Transfers.

Kristy Kummerow Broman, Sharon E Phillips, Jesse M Ehrenfeld

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    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.

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    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.