title: Transfer status: a risk factor for mortality in patients with necrotizing fasciitis.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a rapidly progressive disease that requires urgent surgical debridement for survival. Interhospital transfer (IT) may be associated with delay to operation, which could increase mortality. We hypothesized that mortality would be higher in patients undergoing surgical debridement for necrotizing fasciitis after IT compared to Emergency Department (ED) admission.
  
  
  METHODS
  We performed a retrospective cohort analysis from 2000-2006 using the Nationwide Inpatient Sample. Inclusion criteria were age >18 years, primary diagnosis of NF, and surgical therapy within 72 hours of admission. Logistic regression was used to assess the relationship between admission source, patient and hospital variables, and mortality.
  
  
  RESULTS
  We identified 9,958 cases over the study period. Patients in the ED group were more likely to be nonwhite and of lower income when compared with patients in the IT group. Unadjusted mortality was higher in the IT group than ED group (15.5% vs 8.7%, P < .001). After adjusting for potential confounders, odds of mortality were still greater in the IT (OR 2.04, CI 95% 1.60-2.59, P < .001).
  
  
  CONCLUSIONS
  Interhospital transfer is associated with increased risk of in-hospital mortality after surgical therapy for NF, a finding which persists after controlling for patient and hospital level variables.
authors.affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. daniel.holena@uphs.upenn.edu
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.forename: Angela M
authors.initials: AM
authors.lastname: Mills
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.forename: Chris
authors.initials: C
authors.lastname: Wirtalla
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Kim
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Braslow
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods / Q000401:mortality; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D003646:Debridement / Q000379:methods / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis