title: Patient characteristics, outcomes and costs following interhospital transfer to a tertiary facility for appendectomy versus patients who present directly.
abstract: BACKGROUND
  Recent healthcare policy changes have emphasized pay-for-performance. Previous studies have not examined outcome differences between primary presenting appendicitis patients and transferred patients.
  
  
  METHODS
  A retrospective cohort design examined appendicitis patients between March 2011 and 2013. Patients < age 18, were scheduled for an elective appendectomy, who were pregnant or had an interval appendectomy were excluded.
  
  
  RESULTS
  The transfer cohort (n = 59) had more comorbidities, more severe American Society of Anesthesiologists status, a higher rate of pre-operative abscess/rupture as well as higher rates of perforation, gangrene, intra-operative drain placement and open conversion versus primary presenting patients (n = 622). After statistical regression adjustment, a higher open conversion rate in the transfer cohort, OR = 3.48 (95%CI: 1.04-11.61) and higher total costs $672.47 (95%CI: $68.75-$1276.19) remained.
  
  
  CONCLUSIONS
  Adjustments in clinical outcome/reimbursement metrics may be needed to address the complexity of transfers and the subsequent higher in-hospital costs on tertiary facilities.
  
  
  METHODS
  IV.
authors.affiliation: Department of Surgery, Colon and Rectal Surgery Fellowship, University at Buffalo State, Buffalo, NY, USA. Electronic address: dleberer@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Leberer
authors.affiliation: OhioHealth Research Institute, Columbus, OH, USA. Electronic address: john.elliott@ohiohealth.com.
authors.forename: John O
authors.initials: JO
authors.lastname: Elliott
authors.affiliation: Department of General Surgery, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA. Electronic address: e34dominguez@yahoo.com.
authors.forename: Edward
authors.initials: E
authors.lastname: Dominguez
mesh_terms: D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D010360:Patient Transfer / Q000191:economics*; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Appendectomy; Hospital costs; Outcomes; Transfer patients