Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
J Am Coll Surg. 2019 Jun;228(6):871-877. doi: 10.1016/j.jamcollsurg.2019.01.014. Epub 2019 Jan 31.
Emergency general surgery (EGS) encompasses high-risk patients undergoing high-risk procedures. Admission source, particularly interhospital transfer, is rarely accounted for in clinical performance benchmarking. Our goal was to assess the impact of transfer status on outcomes after EGS.
This was a retrospective analysis of the American College of Surgeons NSQIP database (2005 to 2014). All inpatients that underwent 1 of 7 EGS procedures shown to represent 80% of EGS volume, complications, and mortality nationally were included. Admission source was classified as directly admitted vs transferred from an outside emergency department or an acute care facility. The primary outcomes were overall mortality, overall morbidity, and major morbidity. A 3:1 propensity score matched analysis was used to determine the association of admission source with outcomes. Subgroup analysis was performed for high- and low-risk EGS procedures.
A total of 222,519 EGS admissions were identified, of which 15,232 (6.8%) were transfers. Mean age was 46 years and 51.4% were female. Overall mortality was 3.1% for the entire cohort and 10.8% within the transfer group. After propensity score matched analysis for 33 clinical and demographic variables, transferred patients had higher rates of overall mortality (odds ratio 1.01; 95% CI 1.01 to 1.02), higher overall morbidity (odds ratio 1.07; 95% CI 1.05 to 1.09), and major morbidity (odds ratio 1.06; 95% CI 1.04 to 1.08) compared with directly admitted patients.
After rigorous risk adjustment, interhospital transfer status has a small effect on mortality and morbidity in the EGS population. This could suggest that it is reasonable to transfer patients and that regionalization of care should be encouraged.
急诊普通外科（EGS）涵盖了接受高风险手术的高危患者。入院来源，特别是院内转院，在临床绩效基准评估中很少被考虑。我们的目标是评估转院状态对 EGS 后结果的影响。
这是对美国外科医师学院 NSQIP 数据库（2005 年至 2014 年）的回顾性分析。所有接受了 7 种 EGS 手术之一的住院患者均被纳入研究，这些手术代表了全国 80%的 EGS 量、并发症和死亡率。入院来源分为直接入院和从外部急诊部门或急性护理机构转入。主要结局是总死亡率、总发病率和主要发病率。使用 3:1 倾向评分匹配分析来确定入院来源与结局的关系。对高危和低危 EGS 手术进行了亚组分析。
共确定了 222519 例 EGS 入院患者，其中 15232 例（6.8%）为转院患者。平均年龄为 46 岁，51.4%为女性。整个队列的总死亡率为 3.1%，转院组为 10.8%。在对 33 项临床和人口统计学变量进行倾向评分匹配分析后，转院患者的总死亡率（优势比 1.01；95%可信区间 1.01 至 1.02）、总发病率（优势比 1.07；95%可信区间 1.05 至 1.09）和主要发病率（优势比 1.06；95%可信区间 1.04 至 1.08）均高于直接入院患者。
在严格的风险调整后，院内转院状态对 EGS 人群的死亡率和发病率有较小的影响。这表明转院是合理的，应鼓励区域化治疗。
