title: Lower Extremity Bypass Surgery on Patients Transferred from Other Hospitals is Associated with Increased Morbidity and Mortality.
abstract: BACKGROUND
  Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted from home. The purpose of this study is to identify factors associated with an interfacility transfer in patients with PAD and compare the postoperative outcomes of these patients to those who are directly admitted to the hospital.
  
  
  METHODS
  The 2013 lower extremity revascularization-targeted American College of Surgeons (ACS-National Surgical Quality Improvement Program [NSQIP]) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for transfer to another hospital.
  
  
  RESULTS
  A total of 2,646 patients (65% male, 35% female) were identified in the NSQIP database that underwent lower extremity open revascularization during the year 2013. A total of 287 patients (11%) were transferred from other institutions: acute care hospital inpatient (4%), nursing home/chronic care/intermediate care (3%), outside emergency department (3%), and other (1%). Factors associated with increased risk of interfacility transfer included need for emergency surgery (odds ratio [OR]: 5.51, P < 0.05), infected wounds (OR: 2.77, P < 0.05), and age >85 years (OR: 2.24, P < 0.05). Postoperative outcome associated with transfer was mortality <30 days postop (OR: 1.96) and length of stay >30 days (OR: 2.04; P < 0.05).
  
  
  CONCLUSIONS
  Multiple factors affect an interfacility transfer of patients including advanced age, need for emergency procedure, contaminated wounds. Patients who are transferred from another institution for a lower extremity bypass surgery are at a substantially higher risk for postoperative morbidity and mortality.
authors.affiliation: Division of Vascular Surgery, Penn State Heart and Vascular Institute, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA. Electronic address: faziz@hmc.psu.edu.
authors.forename: Faisal
authors.initials: F
authors.lastname: Aziz
authors.affiliation: Office of Medical Education, Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Youngmin
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010360:Patient Transfer; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000009:adverse effects* / Q000401:mortality