World Journal of Surgery

, Volume 42, Issue 5, pp 1542–1550 | Cite as

Impact of Interhospital Transfer on Outcomes in Non-emergency Colorectal Surgery

  • Stephen P. Sharp
  • Daniel J. Schuster
  • Ashar Ata
  • Brian T. Valerian
  • Jonathan J. Canete
  • A. David Chismark
  • Edward C. Lee
Original Scientific Report



A paucity of data exists on the impact of transfer status on outcomes for patients undergoing non-emergency (urgent) colorectal surgery. This study characterized transferred patients undergoing urgent colorectal surgery and determined which patient comorbidities significantly contributed to poor outcomes.


The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2013 was used. Urgent direct admissions undergoing colon, rectum, or small bowel operations were compared to urgent transfers using bivariate and multivariable analysis models. Primary outcomes were overall complications, hospital length of stay, and mortality.


A total of 82,151 admissions were analyzed. After multivariable analysis, direct admission patients had nearly similar risk of complications (RR = 0.95; 95% CI 0.91–0.99) and length of hospital stay (7% shorter; 95% CI 4–9%), as well as no difference in mortality (RR = 0.94; 95% CI 0.80–1.11).


Transfer status alone confers minimal risk toward higher complication rates and longer hospital length of stay in patients undergoing urgent colorectal surgery, and the poor outcomes observed in this cohort are largely due to patient comorbidities and disease severity. Our results suggest that outcomes in transferred colorectal surgery patients undergoing urgent operations depend mainly on operative acuity and clinical factors, and to a lesser degree transfer status.


Author's contribution

SS, DS and AA contributed to the study design, collected samples, interpreted data, drafted and revised the manuscript. BV, JC, DC and EL contributed to the study design, assisted in drafting and revising the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors are in compliance with all applicable ethical standards.


  1. 1.
    Jancin B (2007) Medicare may drop payments for SSI. Gen Surg News 3:1Google Scholar
  2. 2.
    Yi F (2014) The future of quality measurement in the United States. Clin Colon Rectal Surg 27(1):32–38CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lucas DJ, Ejaz A, Haut ER, Spolverato G, Haider AH, Pawlik TM (2014) Interhospital transfer and adverse outcomes after general surgery: implications for pay for performance. J Am Coll Surg 218(3):393–400CrossRefPubMedGoogle Scholar
  4. 4.
    Flabouris A, Hart GK, George C (2008) Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments. Crit Care Resusc 10(2):97–105PubMedGoogle Scholar
  5. 5.
    Sharp SP, Ata A, Valerian BT, Canete JJ, Chismark AD, Lee EC (2016) Complications and surgical outcomes after interhospital transfer vs direct admission in colorectal surgery: a national surgical quality improvement program analysis. Am J Surg 213(6):1031–1037CrossRefPubMedGoogle Scholar
  6. 6.
    Surgeons ACo (2014) ACS NSQIP. Participant list. Access date August 12, 2014
  7. 7.
    Cohen ME, Ko CY, Bilimoria KY et al (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 217(2):336–346CrossRefPubMedGoogle Scholar
  8. 8.
    Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706CrossRefPubMedGoogle Scholar
  9. 9.
    Friedrich JO, Adhikari NK, Beyene J (2008) The ratio of means method as an alternative to mean differences for analyzing continuous outcome variables in meta-analysis: a simulation study. BMC Med Res Methodol 8:32CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    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):1470–1476CrossRefPubMedGoogle Scholar
  11. 11.
    MacKenzie EJ, Rivara FP, Jurkovich GJ et al (2006) A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 354(4):366–378CrossRefPubMedGoogle Scholar
  12. 12.
    Cantor WJ, Fitchett D, Borgundvaag B et al (2009) Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med 360(26):2705–2718CrossRefPubMedGoogle Scholar
  13. 13.
    Durairaj L, Will JG, Torner JC, Doebbeling BN (2003) Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center. Crit Care Med 31(7):1981–1986CrossRefPubMedGoogle Scholar
  14. 14.
    Santry HP, Janjua S, Chang Y, Petrovick L, Velmahos GC (2011) Interhospital transfers of acute care surgery patients: Should care for nontraumatic surgical emergencies be regionalized? World J Surg 35(12):2660–2667. doi: 10.1007/s00268-011-1292-3 CrossRefPubMedGoogle Scholar
  15. 15.
    Chow CJ, Gaertner WB, Jensen CC, Sklow B, Madoff RD, Kwaan MR (2017) Does hospital transfer impact outcomes after colorectal surgery? Dis Colon Rectum 60(2):194–201CrossRefPubMedGoogle Scholar
  16. 16.
    Cima RR, Lackore KA, Nehring SA et al (2011) How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution. Surgery 150(5):943–949CrossRefPubMedGoogle Scholar
  17. 17.
    Lawson EH, Louie R, Zingmond DS et al (2012) A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 256(6):973–981CrossRefPubMedGoogle Scholar
  18. 18.
    Birkmeyer JD, Shahian DM, Dimick JB et al (2008) Blueprint for a new American College of Surgeons: national surgical quality improvement program. J Am Coll Surg 207(5):777–782CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Stephen P. Sharp
    • 1
  • Daniel J. Schuster
    • 1
  • Ashar Ata
    • 1
  • Brian T. Valerian
    • 1
  • Jonathan J. Canete
    • 1
  • A. David Chismark
    • 1
  • Edward C. Lee
    • 1
    • 2
  1. 1.Division of Colon and Rectal SurgeryAlbany Medical CenterAlbanyUSA
  2. 2.AlbanyUSA

Personalised recommendations