Abstract
Introduction
As the American population ages, the number of geriatric adults requiring emergency
general surgery (EGS) care is increasing. EGS regionalization could significantly
affect the pattern of care for rural older adults. The aim of this study was to determine
the current pattern of care for geriatric EGS patients at our rural academic center,
with a focus on transfer status.
Materials and methods
We performed a retrospective chart review of patients aged ≥65 undergoing EGS procedures
within 48 h of admission from 2014 to 2019 at our rural academic medical center. We
collected demographic, admission, operative, and outcomes data. The primary outcomes
of interest were mortality and nonhome discharge. Univariate and multivariate analyses
were performed.
Results
Over the 5-y study period, 674 patients underwent EGS procedures, with 407 (60%) transferred
to our facility. Transfer patients (TPs) had higher American Society of Anesthesiology
(ASA) scores (P < 0.001), higher rates of open abdomen (13% versus 5.6%, P = 0.001), and multiple operations (24 versus 11%, P < 0.001) than direct admit patients. However, after adjustment there was no difference
in mortality (OR 1.64; 95% CI, 0.82-3.38) or nonhome discharge (OR 1.49; 95% CI, 0.95-2.36).
Conclusions
At our institution, the majority of rural geriatric EGS patients were transferred
from another hospital for care. These patients had higher medical and operative complexity
than patients presenting directly to our facility for care. After adjustment, transfer
status was not independently associated with in-hospital mortality or nonhome discharge.
These patients were appropriately transferred given their level of complexity.
Keywords
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Article info
Publication history
Published online: November 28, 2022
Accepted:
October 16,
2022
Received in revised form:
August 22,
2022
Received:
March 1,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
