Cost Burden and Mortality in Rural Emergency General Surgery Transfer Patients

Recent articles have suggested regionalization of some emergency general surgery (EGS) problems to tertiary referral centers. We sought to characterize the clinical and cost burden of such transfers to our tertiary referral center.

Data were collected retrospectively for nine EGS diagnoses for patients admitted to the EGS service during calendar years 2015 and 2016. Patients were grouped as inpatient transfers (IPTs), Emergency Department transfers (EDTs), or local admissions (LAs). Demographic data, length of stay at originating site, insurance status, Charlson Comorbidity Index, and all relevant financial data were obtained.

Six hundred sixty-three patients were reviewed: 93 IPTs, 343 EDTs, and 227 LAs. IPTs required longer lengths of stay (7.0 d compared to 4.0 d for EDTs and 3.0 d for LAs), higher median direct costs, and higher case mix index, which produced a higher median revenue but averaged a median net loss (-$264 compared to +$2436 for EDTs and +$3125 for LAs). The IPTs had higher median comorbidities (Charlson Comorbidity Index 3.5 versus 2.9 for EDTs and 2.0 for LAs), age (62 y versus 58 for EDTs and 52 for LAs), and mortality rate (7.5% versus 2.3% for EDTs and 0.4% for LAs).

Patients who present to a tertiary care EGS service as an IPT from another hospital have more comorbidities, higher mortality rate, and result in a financial loss. These data suggest the need for adequate risk adjustment in quality assessment of tertiary referral center outcomes and the need for increased financial reimbursement for the care of these patients.