Meta-Analysis of Interhospital Transfer and Mortality After Emergency General Surgery Operations

To evaluate the association between interhospital transfer and postoperative mortality after emergency general surgery operations.

In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement standards, a systematic review including random-effects meta-analysis was conducted. All adult patients undergoing emergency general surgery operations were eligible for inclusion. Interhospital transfer was the prognostic factor of interest and direct admission without transfer was the comparison. Postoperative mortality was the primary outcome and postoperative morbidity was the secondary outcome.

Seven studies (n = 2,863,773) were included. Transferred patients were older (mean difference: 5.91 y, P = 0.010) and more patients in the transferred group were classed as American Society of Anesthesiologists ≥3 (odds ratio [OR]: 2.45, P < 0.001). Although transferred patients underwent more complex procedures such as small bowel resection (OR: 1.49, P = 0.002), colectomy (OR: 1.72, P = 0.002), and perforated peptic ulcer repair (OR: 1.69, P < 0.001), less complex operations such as appendicectomies (OR: 0.60, P = 0.003) were more common in the direct admission group. Pooled unadjusted 30-d mortality was significantly higher in transferred patients (OR: 2.55, P < 0.001) which persisted even after adjustment (OR: 1.26, P = 0.008). Interhospital transfer was associated with higher risk postoperative morbidity (unadjusted OR: 2.06, P = 0.0003; adjusted OR: 1.31, P = 0.003).

Interhospital transfer is associated with increased risks of postoperative mortality and morbidity in emergency general surgery and should be considered as a negative prognostic factor. The poor prognosis may be due to more severe disease, more complex operation, and transfer-related delays.