Transplant Center Treatment in Emergency General Surgery Patients With a Solid-Organ Transplant

We aimed to determine whether treatment at nontransplant centers was associated with worse outcomes for patients with solid organ transplants and an emergency general surgery condition.

Emergency general surgery diagnoses are common and hazardous in patients with solid organ transplants. The ideal hospital for their treatment is controversial.

We performed a retrospective population-based cohort study using linked administrative data in Ontario, Canada. Adults with a solid organ transplant and emergency general surgery condition hospitalized from April 1, 2002, to December 31, 2021, were included. Treatment at a transplant center was compared with other center types. The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, a composite of 30-day complications or mortality, and 30-day readmission. Adjusted analyses used multivariable logistic regression with generalized estimating equations accounting for repeated events.

Among 2679 hospitalizations in this population, 111 (4%) died at 30 days, and 821 (31%) suffered complications or mortality. The adjusted association between 30-day mortality and center depended on transplant type and was higher at academic centers compared with transplant centers (aOR: 3.52, 95% CI: 1.43-8.65, P =0.006) for patients with kidney transplants. There was no association between center and mortality for nonkidney transplants. Regardless of transplant type, the composite of complications or mortality was significantly higher for most center types compared with transplant centers.

Nontransplant centers were associated with higher mortality for patients with kidney transplants, and our composite measure was increased in nontransplant centers for all organs. Emergency general surgery care for these groups should be preferentially offered at transplant centers.