Department of Urology, University of Kentucky, Lexington, KY.
Department of Urology, University of Kentucky, Lexington, KY.
Urology. 2020 Feb;136:100-104. doi: 10.1016/j.urology.2019.11.010. Epub 2019 Nov 18.
To examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers.
Four academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories.
Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302).
Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
检查来自 4 个地理位置不同的学术医疗中心的泌尿科转科和三级中心干预的比例。
选择贝勒医学院、阿拉巴马大学伯明翰分校、肯塔基大学和宾夕法尼亚大学医院（宾大）这 4 所学术医疗中心进行本研究。贝勒医学院和宾大主要服务于大型都会中心城市，而肯塔基大学和阿拉巴马大学伯明翰分校主要服务于大型农村地区人口。在为期 2 年的时间里，每个机构都提取了转科日志，并进行了回顾性图表审查，以评估入院时的转科诊断和程序管理需求。从转科日志数据集提取转科日期、转科诊断和在三级中心入院期间进行的干预。将转科诊断分类为 11 个互斥类别之一。
共有 984 例泌尿科转科患者。69%（682/984）的患者转至 2 个农村中心，30.7%（302/984）的患者转至 2 个都会中心。转科的最常见原因是肾结石，占 26%（256/984 例转科）。本研究中所有泌尿科转科患者的总体手术干预率为 44.4%（437/984 例总转科）。农村中心的转科患者手术干预率低于都会中心（42.7%比 48.3%），并且在研究期间的总转科数量明显更多（682 比 302）。
鉴于大多数患者不需要手术干预，因此需要寻找方法避免不必要的泌尿科转科。
