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Related Experiment Video

Updated: Feb 1, 2026

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

Published on: May 20, 2018

Cost Burden and Mortality in Rural Emergency General Surgery Transfer Patients.

David D Keeven¹, Charles T Harris², Daniel L Davenport²

¹University of Kentucky College of Medicine, Lexington, Kentucky.

The Journal of Surgical Research

|December 12, 2018

Summary

This summary is machine-generated.

Transferring emergency general surgery patients to tertiary centers increases costs and mortality. These inpatient transfers (IPTs) incur financial losses, necessitating better risk adjustment and reimbursement for complex cases.

Keywords:

Bowel obstruction Charlson Comorbidity Index Cost Inpatient Pancreatitis Transfer

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Area of Science:

Surgery
Health Services Research
Healthcare Economics

Background:

Regionalization of emergency general surgery (EGS) to tertiary centers is increasingly proposed.
Tertiary referral centers face unique clinical and financial challenges with these patient transfers.

Purpose of the Study:

To characterize the clinical and cost burden of emergency general surgery transfers to a tertiary referral center.
To compare outcomes and costs of inpatient transfers (IPTs), Emergency Department transfers (EDTs), and local admissions (LAs).

Main Methods:

Retrospective review of 663 patients across nine EGS diagnoses from 2015-2016.
Data included demographics, length of stay, insurance, comorbidities (Charlson Comorbidity Index), and financial data.
Patients categorized as IPTs, EDTs, or LAs.

Main Results:

IPTs had longer lengths of stay (7.0 days vs. 4.0 for EDTs, 3.0 for LAs).
IPTs incurred higher costs and a median net loss (-$264) compared to EDTs (+$2436) and LAs (+$3125).
IPTs presented with higher comorbidity scores, advanced age, and a significantly higher mortality rate (7.5% vs. 2.3% for EDTs, 0.4% for LAs).

Conclusions:

Inpatient transfers to tertiary EGS services have greater comorbidities and higher mortality.
These transfers result in financial losses for the tertiary center.
Risk adjustment in quality assessments and increased reimbursement are needed for managing transferred EGS patients.