Analysis of Organ-Specific Outcomes in Transferred Emergency General Surgery Patients

Interhospital transfer for emergency general surgery (EGS) is often necessary to access a higher level of care. Compared to EGS patients admitted at the operating institution (nontransfer patients), EGS transfer patients represent a higher-risk population. This study sought to evaluate the association between transfer status and postoperative complications in EGS patients.

Using the 2010-2022 American College of Surgeons' National Surgical Quality Improvement Program database, we identified patients aged ≥18 years who underwent an EGS operation. Logistic regression models were used to analyze the association between transfer status and postoperative outcomes while accounting for preoperative risk factors.

We identified 78,513 transferred EGS patients and 560,273 nontransferred EGS patients over 13 years. The median length of hospital stay was twice as long for transfer patients compared to nontransfer patients (4 days versus 2 days). Transfer patients also had higher odds of cardiac (odds ratio 1.08, 95% confidence interval [1.03, 1.14]), pulmonary (1.22, [1.19, 1.26]), infectious (1.06, [1.04, 1.08]), renal (1.09, [1.02, 1.16]), and hematological complications (1.28, [1.25, 1.32]) compared to nontransfer patients. Furthermore, transfer patients had higher odds of unplanned return to the operating room (1.15, [1.11, 1.19]) and mortality within 30 days (1.20, [1.15, 1.24]).

Transferred EGS patients demonstrated higher odds of organ-specific postoperative complications, morbidity, and mortality. Understanding the heightened risk among this patient cohort should encourage the development of transfer and treatment algorithms to anticipate and manage known complications within this high-risk population.