title: Interhospital transfers of acute care surgery patients: should care for nontraumatic surgical emergencies be regionalized?
abstract: BACKGROUND
  Patients with major nontraumatic surgical emergencies (NTSEs) are commonly transferred from small hospitals to tertiary care centers. We hypothesized that transferred patients (TRANS) have worse outcomes than patients with similar diagnoses admitted directly to a tertiary center (DIRECT).
  
  
  METHODS
  We reviewed all patients admitted to the acute care surgery service of our tertiary center (September 1, 2006-October 31, 2009) with one of eight diagnoses indicating a major NTSE. Patients transferred for reasons other than the severity of illness were excluded. Univariate and multivariable analyses compared TRANS and DIRECT patients.
  
  
  RESULTS
  Of 319 patients eligible for analysis, 103 (34%) were TRANS and averaged 3.8 days in the referring hospital before transfer. Compared to DIRECT patients, TRANS patients were more likely to be obese (18.5 vs. 8.0%, P = 0.006) and have cardiac (24 vs. 14%, P = 0.022) or pulmonary (25 vs. 12%, P = 0.003) co-morbidities. TRANS patients were also more likely to present to the tertiary center with hypotension (9 vs. 2%, P = 0.021), tachycardia (20 vs. 13%, P = 0.036), anemia (83 vs. 58%, P < 0.001), and hypoalbuminemia (50 vs. 14%, P < 0.001). TRANS patients had higher mortality (4.9 vs. 0.9%, P = 0.038) and longer hospital stay (8 with 5-13 days vs. 5 with 3-8 days, P < 0.001).
  
  
  CONCLUSIONS
  TRANS patients comprised a significant portion of the population with major NTSEs admitted to the acute care surgery service of our tertiary center. They presented with greater physiologic derangement and had worse outcomes than DIRECT patients. As is currently established for trauma care, regionalization of care for NTSEs should be considered.
authors: Division of Trauma and Critical Care, University of Massachusetts-UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, Massachusetts 01655, USA. Heena.Santry@umassmemorial.org
authors: Heena P
authors: HP
authors: Santry
authors: Sumbal
authors: S
authors: Janjua
authors: Yuchiao
authors: Y
authors: Chang
authors: Laurie
authors: L
authors: Petrovick
authors: George C
authors: GC
authors: Velmahos
mesh_terms: D003422:Critical Care; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011446:Prospective Studies; D013514:Surgical Procedures, Operative