Meta-Analysis of Interhospital Transfer and Mortality After Emergency General Surgery Operations
Ahmad Al-Sarireh1, Hashim Al-Sarireh2, Shahin Hajibandeh3
1University of Cambridge, Cambridge, UK.
The Journal of Surgical Research
|April 10, 2026
Summary
Interhospital transfer in emergency surgery increases patient mortality and morbidity risks. This factor, linked to sicker patients and complex procedures, negatively impacts surgical outcomes.
Area of Science:
- Surgical Outcomes Research
- Health Services Research
- Patient Transfer Analysis
Background:
- Emergency general surgery patients often require transfer between hospitals.
- The impact of interhospital transfer on postoperative outcomes is not fully understood.
- Understanding transfer's role is crucial for optimizing emergency surgical care.
Purpose of the Study:
- To evaluate the association between interhospital transfer and postoperative mortality.
- To assess the relationship between transfer and postoperative morbidity in emergency general surgery.
- To identify interhospital transfer as a prognostic factor in emergency surgery.
Main Methods:
- Systematic review and random-effects meta-analysis adhering to PRISMA standards.
- Inclusion of adult patients undergoing emergency general surgery operations.
- Comparison of outcomes between interhospital transferred patients and directly admitted patients.
Main Results:
- Seven studies (n=2,863,773) revealed transferred patients were older and had higher American Society of Anesthesiologists scores (≥3).
- Transferred patients underwent more complex procedures, yet appendectomies were more common in direct admissions.
- Interhospital transfer significantly increased unadjusted (OR: 2.55) and adjusted (OR: 1.26) 30-day mortality, and postoperative morbidity (adjusted OR: 1.31).
Conclusions:
- Interhospital transfer is a significant negative prognostic factor in emergency general surgery.
- Increased risks of mortality and morbidity are associated with patient transfers.
- Factors contributing to poor prognosis include disease severity, procedural complexity, and transfer delays.
