Jared P Beller1, Robert B Hawkins1, J Hunter Mehaffey1, William Z Chancellor1, Clifford E Fonner2, Alan M Speir3, Mohammed A Quader4, Jeffrey B Rich5, Leora T Yarboro1, Nicholas R Teman1, Gorav Ailawadi6. 1. Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. 2. Virginia Cardiac Services Quality Initiative, Virginia Beach, Va. 3. INOVA Heart and Vascular Institute, Falls Church, Va. 4. Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Va. 5. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 6. Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. Electronic address: Gorav@virginia.edu.
Abstract
OBJECTIVE: Transfer from hospital to hospital for cardiac surgery represents a large portion of some clinical practices. Previous literature in other surgical fields has shown worse outcomes for transferred patients. We hypothesized that transferred patients would be higher risk and demonstrate worse outcomes than those admitted through the emergency department. METHODS: All patients undergoing cardiac operations with a Society of Thoracic Surgeons Predicted Risk of Mortality were evaluated from a multicenter, statewide Society of Thoracic Surgeons database. Only patients requiring admission before surgery were included. Patients were stratified by admission through the emergency department or in transfer. Transfers were further stratified by the cardiothoracic surgery capabilities at the referring center. RESULTS: A total of 13,094 patients met the inclusion criteria of admission before surgery. This included 7582 (57.9%) transfers, of which 502 (6.6%) were referred from cardiac centers. Compared with emergency department admissions, transfers had increased hospital costs despite lower operative risk (Predicted Risk of Mortality 1.5% vs 1.6%, P < .01) and equivalent postoperative morbidity (15.6% vs 15.3% P = .63). In risk-adjusted analysis, transfer status was not independently associated with worse outcomes. Patients transferred from centers that perform cardiac surgery are higher risk than general transfers (Predicted Risk of Mortality 2.5% vs 1.5, P < .01), but specialized care results in excellent risk-adjusted outcomes (observed/expected: mortality 0.81; morbidity or mortality 0.90). CONCLUSIONS: Transfer patients have similar rates of postoperative complications but increased resource use compared with patients admitted through the emergency department. Patients transferred from centers that perform cardiac surgery represent a particularly high-risk subgroup.
OBJECTIVE: Transfer from hospital to hospital for cardiac surgery represents a large portion of some clinical practices. Previous literature in other surgical fields has shown worse outcomes for transferred patients. We hypothesized that transferred patients would be higher risk and demonstrate worse outcomes than those admitted through the emergency department. METHODS: All patients undergoing cardiac operations with a Society of Thoracic Surgeons Predicted Risk of Mortality were evaluated from a multicenter, statewide Society of Thoracic Surgeons database. Only patients requiring admission before surgery were included. Patients were stratified by admission through the emergency department or in transfer. Transfers were further stratified by the cardiothoracic surgery capabilities at the referring center. RESULTS: A total of 13,094 patients met the inclusion criteria of admission before surgery. This included 7582 (57.9%) transfers, of which 502 (6.6%) were referred from cardiac centers. Compared with emergency department admissions, transfers had increased hospital costs despite lower operative risk (Predicted Risk of Mortality 1.5% vs 1.6%, P < .01) and equivalent postoperative morbidity (15.6% vs 15.3% P = .63). In risk-adjusted analysis, transfer status was not independently associated with worse outcomes. Patients transferred from centers that perform cardiac surgery are higher risk than general transfers (Predicted Risk of Mortality 2.5% vs 1.5, P < .01), but specialized care results in excellent risk-adjusted outcomes (observed/expected: mortality 0.81; morbidity or mortality 0.90). CONCLUSIONS: Transfer patients have similar rates of postoperative complications but increased resource use compared with patients admitted through the emergency department. Patients transferred from centers that perform cardiac surgery represent a particularly high-risk subgroup.
Authors: J Hunter Mehaffey; Robert B Hawkins; Matthew G Mullen; Max O Meneveau; Bruce Schirmer; Irving L Kron; R Scott Jones; Peter T Hallowell Journal: J Am Coll Surg Date: 2016-12-23 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: Gorav Ailawadi; Damien J LaPar; Alan M Speir; Ravi K Ghanta; Leora T Yarboro; Ivan K Crosby; D Scott Lim; Mohammed A Quader; Jeffrey B Rich Journal: Ann Thorac Surg Date: 2015-09-26 Impact factor: 4.330