Interhospital transfer for acute surgical care: does delay matter?

Background: Delays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.
Methods: We performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.
Results: The cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.
Conclusions: Delays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.
Competing Interests: Author Disclosures: Drs. Kummerow, Hayes, Ehrenfeld, Holzman, Sharp, Kripalani, Pierce, and Nealon, and Mrs. Phillips have no conflicts of interest to disclose. Dr. Poulose received research support from Bard-Davol and is a consultant to Ariste Medical and Pfizer.
(Published by Elsevier Inc.)