Broman Kristy Kummerow, Phillips Sharon E, Ehrenfeld Jesse M, Patel Mayur B, Guillamondegui Oscar M, Sharp Kenneth W, Pierce Richard A, Poulose Benjamin K, Holzman Michael D
Am Surg. 2017 Aug 1;83(8):866-870.
Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention. One per cent of patient transfers were futile (27/1696). Characteristics of futile transfers included older age, higher comorbidity burden and illness severity, vascular surgery admission, Medicare insurance, and surgeon documentation of end-stage disease as a factor in initial decision-making. Among futile transfers, 82 per cent were designated as do not resuscitate (vs 9% of nonfutile, P < 0.01), and 59 per cent received a palliative care consult (vs 7%, P < 0.01). A small but salient proportion of transferred patients undergo deliberate care de-escalation and early death or hospice discharge without intervention. Efforts to identify such patients before transfer through improved communication between referring and accepting surgeons may mitigate burdens of transfer and facilitate more comfortable deaths in patients' local communities.
外科医生认识到有些外科转诊是徒劳的，但徒劳转诊的发生率和风险因素尚未得到量化。识别徒劳的机构间转诊可以节省成本，并减轻患者及其家庭不必要的负担。我们试图描述徒劳转诊的发生率及相关因素。我们进行了一项回顾性队列研究，研究对象为2009年至2013年间被转诊至一家三级转诊中心接受普通外科或血管外科治疗的患者。徒劳转诊被定义为在转诊后72小时内未进行手术、内镜或放射学干预而导致死亡或临终关怀出院。1%的患者转诊是徒劳的（27/1696）。徒劳转诊的特征包括年龄较大、合并症负担和疾病严重程度较高、血管外科入院、医疗保险以及外科医生将终末期疾病记录为初始决策的一个因素。在徒劳转诊患者中，82%被指定为不进行心肺复苏（而非徒劳转诊患者为9%，P<0.01），59%接受了姑息治疗咨询（而非徒劳转诊患者为7%，P<0.01）。一小部分但显著比例的转诊患者在没有干预的情况下接受了有意的治疗降级以及早期死亡或临终关怀出院。通过改善转诊外科医生和接收外科医生之间的沟通，在转诊前识别此类患者的努力可能会减轻转诊负担，并促进患者在当地社区更安详地离世。
