Patient Transfers and Outcomes in Emergency General Surgery: A Retrospective Analysis.

Area of Science:

• General Surgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Emergency general surgery (EGS) patients often require critical care, and interfacility transfers may be associated with worse outcomes.
• Existing literature suggests potential increases in mortality and complications for transferred EGS patients.

Purpose of the Study:

• To evaluate the impact of patient transfers on mortality in EGS.
• To assess the utilization of damage control laparotomy (DCL) in transferred EGS patients.

Main Methods:

• Retrospective cohort study of 1249 adult patients undergoing emergent non-traumatic exploratory laparotomy from 2013 to 2023.
• Primary outcome: mortality. Secondary outcomes: DCL usage, complications, ICU admission, postoperative ventilation, and hospital length of stay.

Main Results:

• Transferred patients (40.4%) had higher preoperative severity scores (PESAS, ASA) and required DCL more frequently (52% vs 42%).
• Transferred patients experienced higher rates of ICU admission (52% vs 40%) and postoperative ventilation (47% vs 37%).
• While overall complications were higher in transferred patients (50% vs 39%), mortality rates were not significantly different (18% vs 14%).

Conclusions:

• Transferred EGS patients present with greater preoperative acuity and higher DCL utilization.
• Despite increased complications and resource utilization, effective transfer systems and DCL may mitigate mortality risk.