title: Complications and surgical outcomes after interhospital transfer vs direct admission in colorectal surgery: A National Surgical Quality Improvement Program analysis.
abstract: BACKGROUND
  Interhospital transfer is common among patients undergoing colorectal surgery. The purpose of this study was to determine surgical outcomes after transfer vs direct admission in patients undergoing colorectal surgery.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2012 was used. Colorectal operations were selected, including both emergency and nonemergency cases. Transfers were compared with direct admissions using a complex comorbidity analysis model. Primary outcomes of interest were mortality, extended hospital length of stay, and complication rates.
  
  
  RESULTS
  The study included 121,040 admissions. After adjusting for multiple patient factors and comorbidities, nonemergency transfers still had higher mortality rates (RR = 1.20; P < .05), longer length of hospital stay (RR = 1.24; P < .05), and higher complication rates (RR = 1.18; P < .05).
  
  
  CONCLUSIONS
  Preoperative hospital transfer is common among patients requiring colorectal surgery. Despite extensive propensity score matching, nonemergency transfers have higher rates of mortality, longer length of hospital stay, and higher overall complication rates compared with direct admissions. Transfer status is an important variable in hospital performance models and should be taken into consideration when analyzing hospital outcomes.
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA.
authors: Stephen P
authors: SP
authors: Sharp
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA.
authors: Ashar
authors: A
authors: Ata
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA.
authors: Brian T
authors: BT
authors: Valerian
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA.
authors: Jonathan J
authors: JJ
authors: Canete
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA.
authors: A David
authors: AD
authors: Chismark
authors: Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: LeeE@mail.amc.edu.
authors: Edward C
authors: EC
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Colorectal surgery; Hospital transfer; NSQIP; Surgical outcomes