title: Post operative complications in a dedicated elective orthopaedic hospital: transfers requiring specialist critical care support.
abstract: We aim to report our experience with out of hospital transfers for postoperative complications in a stand-alone elective orthopaedic hospital. We aim to describe the cohort of patients transferred, the rate of transfer and assess the risk factors for transfer. Patients were identified who were transferred out of the hospital to another acute hospital for management of non-routine medical problems. Patient data was collected relating to age, BMI, ASA, type of surgery, nature of the complication, timing and the outcome of transfer. In 2012, 2,853 inpatient surgical procedures were carried out, 51 patients (1.8%) developed a postoperative complication that required out of hospital transfer. Mean age of patients transferred was 67 (12-86) years, mean age of the overall case mix 58 years (0-96) (p = 0.01). 37.7% of the overall case mix of surgeries was made up of primary hip and knee arthroplasty procedures, these patients made up 63.7% of patients transferred out (p = 0.001). Mean BMI recorded was 31.7 (22-48) compared to the mean BMI of the total arthroplasty case mix of 28.8 (20-44) (p = 0.02). 59% of all patients at our institution were ASA category II or III. 76% of patients transferred were ASA category II or III (p = 0.005). We can conclude that patients requiring transfer are typically older. Arthroplasty patients are more likely to require transfer than patients undergoing other orthopaedic procedures. Among the arthroplasty cohort transferred patients will typically have a higher BMI than average. Patients with ASA category II or III make up nearly three quarters of those patients transferred. The mean age of patients transferred is typically older by 9 years.
authors.forename: P
authors.initials: P
authors.lastname: Dawson
authors.forename: A
authors.initials: A
authors.lastname: Daly
authors.forename: D
authors.initials: D
authors.lastname: Lui
authors.forename: J S
authors.initials: JS
authors.lastname: Butler
authors.forename: J
authors.initials: J
authors.lastname: Cashman
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods / Q000458:organization & administration; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006782:Hospitals, Special / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D008297:Male; D020380:Needs Assessment; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors