Table 2:
Characteristics of Transferred Emergency General Surgery Episodes of Care
| Type of Transfer Episode | |||
|---|---|---|---|
| Characteristic | All Transfers (N=26,281) | ED-Inpatient (N=17,070) | Inpatient-Inpatient (N=9,211) |
| Patient Demographics | |||
| Age (years) | 62 [47–75] | 60 [45–74] | 65 [51–76] |
| Female | 13,520 (51.4) | 8,936 (52.4) | 4,584 (49.8) |
| Race* | |||
| White | 19,986 (80.4) | 13,136 (81.4) | 6,850 (78.6) |
| Black | 3,226 (13.0) | 1,998 (12.4) | 1,228 (14.1) |
| Other | 1,642 (6.6) | 1,005 (6.2) | 637 (7.3) |
| Hispanic † | 1,849 (7.4) | 1,171 (7.2) | 678 (7.8) |
| Insurance † | |||
| Government Insurance | 18,020 (68.6) | 11,437 (67.1) | 6,583 (71.5) |
| Private Insurance | 6,392 (24.3) | 4,305 (25.2) | 2,087 (22.7) |
| Self-Pay | 1,023 (3.9) | 735 (4.3) | 288 (3.1) |
| Other | 831 (3.2) | 581 (3.4) | 250 (2.7) |
| Referral Hospital Characteristics | |||
| Hospital size | |||
| <100 beds | 10,675 (40.6) | 8,163 (47.8) | 2,512 (27.3) |
| 100–250 beds | 8,124 (30.9) | 4,723 (27.7) | 3,401 (36.9) |
| >250 beds | 7,474 (28.5) | 4,176 (24.5) | 3,298 (35.8) |
| ICU beds | |||
| 0 to 10 beds | 11,455 (43.6) | 8,650 (50.7) | 2,805 (30.5) |
| 11 to 25 beds | 6,321 (24.1) | 3,697 (21.7) | 2,624 (28.5) |
| >25 beds | 8,497 (32.3) | 4,715 (27.6) | 3,782 (41.1) |
| Teaching hospital | 8,495 (32.3) | 4,767 (27.9) | 3,728 (40.5) |
| Trauma Center Designation | |||
| Non-trauma center | 23,183 (88.2) | 15,203 (89.1) | 7,980 (86.6) |
| Level 3 | 967 (3.7) | 610 (3.6) | 357 (3.9) |
| Level 2 | 812 (3.1) | 424 (2.5) | 388 (4.2) |
| Level 1 | 1,319 (5.0) | 833 (4.9) | 486 (5.3) |
| Hospital ownership | |||
| Government | 2,308 (8.8) | 1,504 (8.8) | 804 (8.7) |
| Non-profit | 18,947 (72.1) | 12,480 (73.2) | 6,467 (70.2) |
| For-profit | 5,018 (19.1) | 3,078 (18.0) | 1,940 (21.1) |
| Rural hospital | 3.561 (13.6) | 2,816 (16.5) | 745 (8.1) |
| Critical access hospital | 4,739 (18.0) | 3,921 (23.0) | 818 (8.9) |
| U.S. Region § | |||
| Northeast | 9,526 (36.3) | 6,340 (37.1) | 3,186 (34.6) |
| Midwest | 4,670 (17.8) | 3,267 (19.1) | 1,403 (15.2) |
| South | 12,085 (46.0) | 7,463 (43.7) | 4,622 (50.2) |
| Transfer Characteristics | |||
| Potentially avoidable transfer ∥ | 7,188 (27.4) | 5,415 (31.7) | 1,773 (19.3) |
| Weekend transfer ¶ | 7,079 (26.9) | 4,940 (28.9) | 2,139 (23.2) |
| Nighttime transfer # | 9,688 (56.0) | 6,281 (57.2) | 3,407 (54.0) |
| Transfer distance (miles) | 23.4 [9.4–41.7] | 24.1 [10.8, 40.9] | 20.3 [8.0–42.7] |
| Operation or Procedure use | |||
| Any operation or procedure during episode | 11,947 (45.5) | 6,941 (40.7) | 5,006 (54.4) |
| Pre-transfer only | 1,212 (4.6) | - | 1,212 (13.2) |
| Post-transfer only | 9,816 (37.4) | 6,941 (40.7) | 2,875 (31.2) |
| Both pre-transfer and post-transfer | 919 (3.5) | - | 919 (10.0) |
| Neither pre-transfer nor post-transfer | 14,334 (54.5) | 10,129 (59.3) | 4,205 (45.7) |
| Outcomes | |||
| Complication ** | 5,327 (20.3) | 2,318 (13.6) | 3,009 (32.7) |
| In-hospital death | 944 (3.6) | 451 (2.6) | 493 (5.4) |
| With surgery or procedure | 529 (4.4) n=11,947 |
227 (3.3) n=6,941 |
302 (6.0) n=5,006 |
| Without surgery or procedure | 415 (2.9) n=14,334 |
224 (2.2) n=10,129 |
191 (4.5) n=4,205 |
| Failure to rescue †† | 480 (9.0) n=5,327 |
192 (8.3) n=2,318 |
288 (9.6) n=3,009 |
All results are median [interquartile range] or frequency (%).
Abbreviations: ED=emergency department, ICU=intensive care unit, U.S.=United States.
Race was available for 94.6% of all transfer episodes.
Hispanic ethnicity was available for 94.7% of all transfer episodes.
Insurance information was available for 99.9% of all transfer episodes.
U.S. regions were based on geographical regions defined by the U.S. Census Bureau.(29)
Potentially avoidable transfers were defined as post-transfer discharge within 72 hours without undergoing any procedure or operation at the destination hospital.
Weekend transfers were defined as transfers that occurred on Saturday or Sunday.
Nighttime transfers were defined as transfers that occurred between 6:00 PM and 6:00 AM the following day. Data were not available for Massachusetts, Maryland, and Wisconsin. Data were available for 65.8% of all transfer episodes.