Interfacility Transfer for Nonelective Cholecystectomy in High MELD Patients: An ACS-NSQIP Analysis

Area of Science:

• Hepatology
• Surgical Outcomes
• Health Services Research

Background:

• Interfacility transfer is common for liver disease patients needing urgent cholecystectomy due to complexity and risk.
• The impact of transfer on outcomes for these patients remains unclear.

Purpose of the Study:

• To investigate the association between Model for End Stage Liver Disease (MELD) score, transfer frequency, and outcomes in patients undergoing nonelective cholecystectomy.
• To determine if interfacility transfer impacts mortality, complications, length-of-stay, reoperation, and readmission rates.

Main Methods:

• Analysis of the ACS-NSQIP participant use files for nonelective cholecystectomies (2016-2018).
• Patients stratified by MELD score (low, intermediate, high).
• Comparison of outcomes between transferred and non-transferred patients within the high MELD group using multivariate regression.

Main Results:

• Transfer frequency increased with higher MELD scores.
• High MELD patients had worse outcomes (LOS, reoperation, readmission, mortality).
• Transferred high MELD patients were older, more likely white, obese, and septic, with higher mortality and reoperation rates, but transfer status was not an independent predictor of mortality, complications, or LOS.

Conclusions:

• Interfacility transfer is not independently associated with mortality, postoperative complications, or prolonged length-of-stay in patients with advanced liver disease undergoing acute cholecystectomy.
• These findings suggest that interfacility transfer may not offer significant benefits for this patient population.