Stephen P Sharp1, Daniel J Schuster1, Ashar Ata1, Brian T Valerian1, Jonathan J Canete1, A David Chismark1, Edward C Lee2,3. 1. Division of Colon and Rectal Surgery, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA. 2. Division of Colon and Rectal Surgery, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA. LeeE@mail.amc.edu. 3. , 50 New Scotland Avenue, MC-193, 6th Floor, Albany, NY, 12208, USA. LeeE@mail.amc.edu.
Abstract
BACKGROUND: A paucity of data exists on the impact of transfer status on outcomes for patients undergoing non-emergency (urgent) colorectal surgery. This study characterized transferred patients undergoing urgent colorectal surgery and determined which patient comorbidities significantly contributed to poor outcomes. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2013 was used. Urgent direct admissions undergoing colon, rectum, or small bowel operations were compared to urgent transfers using bivariate and multivariable analysis models. Primary outcomes were overall complications, hospital length of stay, and mortality. RESULTS: A total of 82,151 admissions were analyzed. After multivariable analysis, direct admission patients had nearly similar risk of complications (RR = 0.95; 95% CI 0.91-0.99) and length of hospital stay (7% shorter; 95% CI 4-9%), as well as no difference in mortality (RR = 0.94; 95% CI 0.80-1.11). CONCLUSIONS: Transfer status alone confers minimal risk toward higher complication rates and longer hospital length of stay in patients undergoing urgent colorectal surgery, and the poor outcomes observed in this cohort are largely due to patient comorbidities and disease severity. Our results suggest that outcomes in transferred colorectal surgery patients undergoing urgent operations depend mainly on operative acuity and clinical factors, and to a lesser degree transfer status.
BACKGROUND: A paucity of data exists on the impact of transfer status on outcomes for patients undergoing non-emergency (urgent) colorectal surgery. This study characterized transferred patients undergoing urgent colorectal surgery and determined which patient comorbidities significantly contributed to poor outcomes. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2013 was used. Urgent direct admissions undergoing colon, rectum, or small bowel operations were compared to urgent transfers using bivariate and multivariable analysis models. Primary outcomes were overall complications, hospital length of stay, and mortality. RESULTS: A total of 82,151 admissions were analyzed. After multivariable analysis, direct admission patients had nearly similar risk of complications (RR = 0.95; 95% CI 0.91-0.99) and length of hospital stay (7% shorter; 95% CI 4-9%), as well as no difference in mortality (RR = 0.94; 95% CI 0.80-1.11). CONCLUSIONS: Transfer status alone confers minimal risk toward higher complication rates and longer hospital length of stay in patients undergoing urgent colorectal surgery, and the poor outcomes observed in this cohort are largely due to patient comorbidities and disease severity. Our results suggest that outcomes in transferred colorectal surgery patients undergoing urgent operations depend mainly on operative acuity and clinical factors, and to a lesser degree transfer status.
Authors: John D Birkmeyer; David M Shahian; Justin B Dimick; Samuel R G Finlayson; David R Flum; Clifford Y Ko; Bruce Lee Hall Journal: J Am Coll Surg Date: 2008-09-19 Impact factor: 6.113
Authors: Stephen P Sharp; Ashar Ata; Brian T Valerian; Jonathan J Canete; A David Chismark; Edward C Lee Journal: Am J Surg Date: 2016-09-02 Impact factor: 2.565
Authors: Robert R Cima; Kandace A Lackore; Sharon A Nehring; Stephen D Cassivi; John H Donohue; Claude Deschamps; Monica Vansuch; James M Naessens Journal: Surgery Date: 2011-08-27 Impact factor: 3.982
Authors: Christopher J Chow; Wolfgang B Gaertner; Christine C Jensen; Bradford Sklow; Robert D Madoff; Mary R Kwaan Journal: Dis Colon Rectum Date: 2017-02 Impact factor: 4.585
Authors: Felix Walther; Jochen Schmitt; Maria Eberlein-Gonska; Ralf Kuhlen; Peter Scriba; Olaf Schoffer; Martin Roessler Journal: BMJ Open Date: 2022-07-25 Impact factor: 3.006