Complications and surgical outcomes after interhospital transfer vs direct admission in colorectal surgery: A National Surgical Quality Improvement Program analysis

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. (C) 2016 Elsevier Inc. All rights reserved.