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Transfer Status: A Driver of Failure-to-Rescue in Emergency General Surgery
Blake R Miller1, Sonia Slusarczyk1, Amir Farah1
1Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
The American Surgeon
|September 17, 2025
Summary
Emergency general surgery patients transferred between hospitals have higher complication, mortality, and failure-to-rescue rates. This study highlights a vulnerable patient group needing further research into modifiable risk factors.
Area of Science:
- Surgical Outcomes Research
- Healthcare Quality Improvement
- Patient Transfer Analysis
Background:
- Interfacility transfer (IFT) in emergency general surgery (EGS) is linked to increased complications and mortality.
- Failure-to-rescue (FTR) rates in transferred EGS patients are understudied.
- Transferred patients may face distinct disadvantages compared to direct admissions.
Purpose of the Study:
- To investigate whether IFT is associated with higher risk-adjusted FTR rates in EGS patients.
- To compare FTR rates between directly admitted and interfacility transferred EGS patients.
- To identify potential disparities in outcomes for transferred EGS patients.
Main Methods:
- Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database (2016-2020).
- Inclusion of adult patients undergoing high-risk EGS procedures (enterectomy, colectomy, peptic ulcer surgery, laparotomy).
- Multivariable logistic regression models adjusted for demographics, comorbidities, and procedure type to assess IFT impact.
Main Results:
- IFT patients (21.4%) had significantly higher odds of major complications (OR 1.09), mortality (OR 1.23), and FTR (OR 1.12) after risk adjustment.
- The study analyzed 70,028 EGS patients, with 15,032 undergoing IFT.
- Transferred patients demonstrated a distinct disadvantage in key adverse outcome metrics.
Conclusions:
- Interfacility transfer is an independent predictor of worse outcomes in EGS, including elevated FTR rates.
- IFT patients represent a vulnerable EGS subpopulation requiring clinical attention.
- Further research is needed to identify and address modifiable risk factors contributing to outcome disparities in transferred EGS patients.
