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Multicenter Study
. 2019 Nov:243:391-398.
doi: 10.1016/j.jss.2019.05.040. Epub 2019 Jul 2.

Percentage of Mortal Encounters Transferred in Emergency General Surgery

Margaret H Lauerman  1 , Anthony V Herrera  2 , Jennifer S Albrecht  3 , Hegang H Chen  3 , Brandon R Bruns  2 , Ronald B Tesoriero  2 , Thomas M Scalea  2 , Jose J Diaz  2
Affiliations
Multicenter Study

Percentage of Mortal Encounters Transferred in Emergency General Surgery

Margaret H Lauerman et al. J Surg Res. 2019 Nov.

Abstract

Background: Despite the frequent occurrence of interhospital transfers in emergency general surgery (EGS), rates of transfer of complications are undescribed. Improved understanding of hospital transfer patterns has a multitude of implications, including quality measurement. The objective of this study was to describe individual hospital transfer rates of mortal encounters.

Materials and methods: A retrospective review was undertaken from 2013 to 2015 of the Maryland Health Services Cost Review Commission database. Two groups of EGS encounters were identified: encounters with death following transfer and encounters with death without transfer. The percentage of mortal encounters transferred was defined as the percentage of EGS hospital encounters with mortality initially presenting to a hospital transferred to another hospital before death at the receiving hospital.

Results: Overall, 370,242 total EGS encounters were included, with 17,003 (4.6%) of the total EGS encounters with mortality. Encounters with death without transfer encompassed 15,604 (91.8%) of mortal EGS encounters and encounters with death following transfer 1399 (8.2%). EGS disease categories of esophageal varices or perforation, necrotizing fasciitis, enterocutaneous fistula, and pancreatitis had over 10% of these total mortal encounters with death following transfer. For individual hospitals, percentage of mortal encounters transferred ranged from 0.8% to 35.2%. The percentage of mortal encounters transferred was inversely correlated with annual EGS hospital volume for all state hospitals (P < 0.001, r = -0.57).

Conclusions: Broad variability in individual hospital practices exists for mortality transferred to other institutions. Application of this knowledge of percentage of mortal encounters transferred includes consideration in hospital quality metrics.

Keywords: Emergency general surgery; Interhospital transfer.

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Figures

Fig. 1 –
Fig. 1 –
Flow diagram for group creation.
Fig. 2 –
Fig. 2 –
Distribution of encounters with death following transfer stratified by trauma center status.
Fig. 3 –
Fig. 3 –
Percentages of encounters with mortality following transfer and encounters with mortality without transfer stratified by common emergency general surgery (EGS) diseases.
Fig. 4 –
Fig. 4 –
Funnel plot comparing the percentage of mortal encounters transferred from each hospital with annual EGS hospital volume. (Color version of figure is available online.)
See this image and copyright information in PMC

References

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