title: Transfer status is a risk factor for increased in-hospital mortality in patients with diverticular hemorrhage.
abstract: OBJECTIVE
  Gastrointestinal tract hemorrhage is a common problem accounting for approximately 1 % of hospital admissions. It is estimated that one third of the episodes of lower gastrointestinal hemorrhage are secondary to diverticular disease. Inter-institutional transfer has been associated with delay in care and increased in-hospital mortality. We hypothesized that patients with diverticular hemorrhage that were transferred from an acute care hospital to tertiary care institutions have increased in-hospital morbidity and mortality when compared to primarily admitted patients.
  
  
  METHODS
  We performed a retrospective analysis of the Nationwide Inpatient Sample for the year 2008. Patients with a primary discharge diagnosis of diverticular hemorrhage were selected. Multivariate logistic regression was used to identify the relationship between transfer status and in-hospital mortality.
  
  
  RESULTS
  A total of 99,415 hospitalizations for diverticular hemorrhage were identified. Transferred patients had higher in-hospital mortality rates compared to primarily admitted patients (3.5 vs. 1.8 %, p < 0.001), as well as increased length of stay (8.4 vs. 5.4 days, p < 0.001) and a higher rate of total abdominal colectomy (1.2 vs. 0.6 %, p < 0.001). Multivariate analysis indicated that transfer status was associated with increased in-hospital mortality [OR 1.8, 95 % CI 1.5-2.8, p < 0.001].
  
  
  CONCLUSIONS
  Inter-institutional transfer for diverticular bleeding is associated with increased in-hospital mortality, increased total abdominal colectomy rate, as well as increased economic burden including mean length of stay and total hospital charges. Further prospective studies are needed to analyze the clinical information of patients requiring transfer to another hospital in order to identify those patients who would truly benefit from inter-institutional transfer.
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, CMP 2S, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. haisardao@gmail.com
authors.forename: Haisar E
authors.initials: HE
authors.lastname: Dao
authors.forename: Peter E
authors.initials: PE
authors.lastname: Miller
authors.forename: Justin H
authors.initials: JH
authors.lastname: Lee
authors.forename: Reza
authors.initials: R
authors.lastname: Kermani
authors.forename: Alan W
authors.initials: AW
authors.lastname: Hackford
mesh_terms: D000368:Aged; D004238:Diverticulitis / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology