Transfer of Acute Care Surgery Patients in a Rural State: A Concerning Trend

• Published in: The Journal of surgical research Vol. 206; no. 1; pp. 168 - 174
• Main Authors: Misercola, Brittany, MD, Sihler, Kristen, MD, FACS, Douglas, Molly, MD, Ranney, Stephen, BS, Dreifus, Jonathan, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Acute care surgery; Adolescent; Adult; Aged; Aged, 80 and over; Critical Care; Female; Health Services Accessibility - statistics & numerical data; Humans; Interhospital; Length of Stay - statistics & numerical data; Maine; Male; Middle Aged; Patient Transfer - statistics & numerical data; Retrospective Studies; Rural; Rural Health Services - organization & administration; Rural Health Services - statistics & numerical data; Surgery; Surgical Procedures, Operative - statistics & numerical data; Tertiary Care Centers - organization & administration; Tertiary Care Centers - statistics & numerical data; Transfer; Young Adult; Rural; Acute care surgery; Transfer; Interhospital
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.06.090

Abstract Background Regionalized care of complex patients to larger hospitals is an increasingly common practice as the population ages and the physician shortage evolves. The Acute Care Surgery (ACS) model is new, and there is limited data on the patients being transferred through this system. We hypothesized transfer patients would be older, more complex, and require additional resources. Materials and Methods Retrospective chart review of ACS patients admitted to a single tertiary facility. Patient demographics, clinical presentation, and outcomes were obtained. Results We found our 161 transferred patients (TP) were older (61.2 v 54.7 years [p<0.001]), had more comorbidities (CCI 4 v 3.1 [p<0.001]), and required more resources than 611 local patients (LP) (LOS 8.2 v 3.4 [p<0.001], ICU admission 24% v 6% of patients [p<0.001]). Admission diagnosis was similar, with pancreaticobiliary (TP 29% v LP 30%) and small bowel (TP 25% v LP 23%) complaints most common. Most common intervention was laparoscopic cholecystectomy for both (29% v 25%). Subspecialty interventions were similar (IR, advanced endoscopy) at TP 10% and LP 8%. TP were more likely to not require a procedure (31% v 23%). Insurance provider differed between groups, particularly for Medicare (55% v 34%) and privately insured (26% v 45%). Conclusions While this study confirms transfer patients need the resources for which they were referred to a tertiary center, we unexpectedly found nearly half of transfer patients undergo basic surgical procedures or do not require intervention. This points to a concerning lack of general surgery resources in the community.