International Journal of Colorectal Disease

, Volume 28, Issue 2, pp 273–276 | Cite as

Transfer status is a risk factor for increased in-hospital mortality in patients with diverticular hemorrhage

  • Haisar E. DaoEmail author
  • Peter E. Miller
  • Justin H. Lee
  • Reza Kermani
  • Alan W. Hackford
Original Article



Gastrointestinal tract hemorrhage is a common problem accounting for approximately 1 % of hospital admissions. It is estimated that one third of the episodes of lower gastrointestinal hemorrhage are secondary to diverticular disease. Inter-institutional transfer has been associated with delay in care and increased in-hospital mortality. We hypothesized that patients with diverticular hemorrhage that were transferred from an acute care hospital to tertiary care institutions have increased in-hospital morbidity and mortality when compared to primarily admitted patients.

Materials and methods

We performed a retrospective analysis of the Nationwide Inpatient Sample for the year 2008. Patients with a primary discharge diagnosis of diverticular hemorrhage were selected. Multivariate logistic regression was used to identify the relationship between transfer status and in-hospital mortality.


A total of 99,415 hospitalizations for diverticular hemorrhage were identified. Transferred patients had higher in-hospital mortality rates compared to primarily admitted patients (3.5 vs. 1.8 %, p < 0.001), as well as increased length of stay (8.4 vs. 5.4 days, p < 0.001) and a higher rate of total abdominal colectomy (1.2 vs. 0.6 %, p < 0.001). Multivariate analysis indicated that transfer status was associated with increased in-hospital mortality [OR 1.8, 95 % CI 1.5–2.8, p < 0.001].


Inter-institutional transfer for diverticular bleeding is associated with increased in-hospital mortality, increased total abdominal colectomy rate, as well as increased economic burden including mean length of stay and total hospital charges. Further prospective studies are needed to analyze the clinical information of patients requiring transfer to another hospital in order to identify those patients who would truly benefit from inter-institutional transfer.


Diverticular hemorrhage Transfer status Mortality Total abdominal colectomy 


  1. 1.
    Chen C-Y, Wu C-C, Shu-Wen J, Pai L, Hsiao C-W (2009) Colonic diverticular bleeding with comorbid diseases may need elective colectomy. J Gastrointest Surg 13(3):516–520PubMedCrossRefGoogle Scholar
  2. 2.
    Csikesz NG, Singla A, Simons JP, Tseng JF, Shah SA (2009) The impact of socioeconomic status on presentation and treatment of diverticular disease. J Gastrointest Surg 13(11):1993–2001, discussion 2001–2. Epub 2009 Sep 16PubMedCrossRefGoogle Scholar
  3. 3.
    Lee KK, Shah SM, Moser MA (2011) Risk factors predictive of severe diverticular hemorrhage. Int J Surg 9(1):83–85, Epub 2010 Oct 14PubMedCrossRefGoogle Scholar
  4. 4.
    Golestanian E, Scruggs JE, Gangnon RE, Mak RP, Wood KE (2007) Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center. Crit Care Med 35(6):1470–1476PubMedCrossRefGoogle Scholar
  5. 5.
    Holena DN, Mills AM, Carr BG, Wirtalla C, Sarani B, Kim PK, Braslow BM, Kelz RR (2011) Transfer status: a risk factor for mortality in patients with necrotizing fasciitis. Surgery 150(3):363–370, Epub 2011 Jul 23PubMedCrossRefGoogle Scholar
  6. 6.
    Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) (2008) Agency for Healthcare Research and Quality, Rockville, MD. Accessed 15 Jul 2011
  7. 7.
    Etzioni AD, Mack TM, Beart RW, Kaiser AK (2009) Diverticulitis in the United States: 1998–2005. Changing patterns of disease and treatment. Ann Surg 249(2):210–217PubMedCrossRefGoogle Scholar
  8. 8.
    Hoedema RE, Luchtefeld MA (2005) The management of lower gastrointestinal hemorrhage. Dis Colon Rectum 48(11):2010–2024PubMedCrossRefGoogle Scholar
  9. 9.
    Parkes BM, Obeid FN, Sorensen VJ, Horst HM, Fath JJ (1993) The management of massive lower gastrointestinal bleeding. Am Surg 59(10):676–678PubMedGoogle Scholar
  10. 10.
    Poncet G, Heluwaert F, Voirin D, Bonaz B, Faucheron JL (2010) Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients. Aliment Pharmacol Ther 32(3):466–471, Epub 2010 May 18PubMedCrossRefGoogle Scholar
  11. 11.
    Klas JV, Madoff RD (1997) Surgical options in lower gastrointestinal bleeding. Semin Colon Rectal Surg 8:172–177Google Scholar
  12. 12.
    Rosenberg AL, Hofer TP, Strachan C, Watts CM, Hayward RA (2003) Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures. Ann Intern Med 138(11):882–890PubMedGoogle Scholar
  13. 13.
    MacDowell M, Glasser M, Fitts M, Nielsen K, Hunsaker M (2010) A national view of rural health workforce issues in the USA. Rural Remote Heal 10(3):1531Google Scholar
  14. 14.
    Napolitano LM, Fulda GJ, Davis KA, Ashley DW, Friese R, Van Way CW, Meredith JW, Fabian TC, Jurkovich GJ, Peitzman AB (2010) Challenging issues in surgical critical care, trauma, and acute care surgery: a report from the Critical Care Committee of the American Association for the Surgery of Trauma. J Trauma 69(6):1619–1633PubMedCrossRefGoogle Scholar
  15. 15.
    Britt RC, Weireter LJ, Britt LD (2009) Initial implementation of an acute care surgery model: implications for timeliness of care. J Am Coll Surg 209(4):421–424PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Haisar E. Dao
    • 1
    Email author
  • Peter E. Miller
    • 1
  • Justin H. Lee
    • 1
  • Reza Kermani
    • 1
  • Alan W. Hackford
    • 1
  1. 1.Department of Surgery, Division of Colorectal Surgery, CMP 2S, Steward St. Elizabeth’s Medical CenterTufts University School of MedicineBostonUSA

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