Complexity of Transferred Geriatric Adults Requiring Emergency General Surgery: A Rural Tertiary Center Experience

Published:November 28, 2022DOI:



      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.


      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).


      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.


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        • Vespa J.
        • Medina L.
        • Armstrong D.M.
        Demographic Turning Points for the United States: Population Projections for 2020 to 2060.
        U.S. Census Bureau, 2020: 25-1144
        • Shafi S.
        • Aboutanos M.B.
        • Agarwal S.
        • et al.
        Emergency general surgery: definition and estimated burden of disease.
        J Trauma Acute Care Surg. 2013; 74: 1092-1097
        • Havens J.M.
        • Peetz A.B.
        • Do W.S.
        • et al.
        The excess morbidity and mortality of emergency general surgery.
        J Trauma Acute Care Surg. 2015; 78: 306-311
        • Lee K.C.
        • Sturgeon D.
        • Lipsitz S.
        • Weissman J.S.
        • Mitchell S.
        • Cooper Z.
        Mortality and health care utilization among Medicare patients undergoing emergency general surgery vs those with acute medical conditions.
        JAMA Surg. 2020; 155: 216-223
        • Ogola G.O.
        • Gale S.C.
        • Haider A.
        • Shafi S.
        The financial burden of emergency general surgery: national estimates 2010 to 2060.
        J Trauma Acute Care Surg. 2015; 79: 444-448
        • Shah A.A.
        • Haider A.H.
        • Zogg C.K.
        • et al.
        National estimates of predictors of outcomes for emergency general surgery.
        J Trauma Acute Care Surg. 2015; 78: 482-491
        • Matsuyama T.
        • Iranami H.
        • Fujii K.
        • Inoue M.
        • Nakagawa R.
        • Kawashima K.
        Risk factors for postoperative mortality and morbidities in emergency surgeries.
        J Anesth. 2013; 27: 838-843
        • Urrechaga E.M.
        • Cioci A.C.
        • Parreco J.P.
        • et al.
        The hidden burden of unplanned readmission after emergency general surgery.
        J Trauma Acute Care Surg. 2021; 91: 891-897
        • Lee K.C.
        • Streid J.
        • Sturgeon D.
        • et al.
        The impact of frailty on long-term patient-oriented outcomes after emergency general surgery: a retrospective cohort study.
        J Am Geriatr Soc. 2020; 68: 1037-1043
        • Kenawy D.M.
        • Renshaw S.M.
        • George E.
        • Malik A.T.
        • Collins C.E.
        Increasing frailty in geriatric emergency general surgery: a cause for concern.
        J Surg Res. 2021; 266: 320-327
        • Chaudhary M.A.
        • Shah A.A.
        • Zogg C.K.
        • et al.
        Differences in rural and urban outcomes: a national inspection of emergency general surgery patients.
        J Surg Res. 2017; 218: 277-284
        • de Jager E.
        • Chaudhary M.A.
        • Rahim F.
        • et al.
        The impact of income on emergency general surgery outcomes in urban and rural areas.
        J Surg Res. 2020; 245: 629-635
        • Keeven D.D.
        • Harris C.T.
        • Davenport D.L.
        • Smalls B.
        • Bernard A.C.
        Cost burden and mortality in rural emergency general surgery transfer patients.
        J Surg Res. 2019; 234: 60-64
        • Yelverton S.
        • Rozario N.
        • Matthews B.D.
        • Reinke C.E.
        Interhospital transfer for emergency general surgery: an independent predictor of mortality.
        Am J Surg. 2018; 216: 787-792
        • Castillo-Angeles M.
        • Uribe-Leitz T.
        • Jarman M.
        • et al.
        Transferred emergency general surgery patients are at increased risk of death: a NSQIP propensity score matched analysis.
        J Am Coll Surg. 2019; 228: 871-877
        • Ingraham A.
        • Wang X.
        • Havlena J.
        • et al.
        Factors associated with the interhospital transfer of emergency general surgery patients.
        J Surg Res. 2019; 240: 191-200
        • Fernandes-Taylor S.
        • Yang D.Y.
        • Schumacher J.
        • Ljumani F.
        • Fertel B.S.
        • Ingraham A.
        Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
        Am J Emerg Med. 2021; 40: 83-88
        • Philip J.L.
        • Yang D.Y.
        • Wang X.
        • et al.
        Effect of transfer status on outcomes of emergency general surgery patients.
        Surgery. 2020; 168: 280-286
        • Mehta A.
        • Dultz L.A.
        • Joseph B.
        • et al.
        Emergency general surgery in geriatric patients: a statewide analysis of surgeon and hospital volume with outcomes.
        J Trauma Acute Care Surg. 2018; 84: 864-875
        • Mehta A.
        • Varma S.
        • Efron D.T.
        • et al.
        Emergency general surgery in geriatric patients: how should we evaluate hospital experience?.
        J Trauma Acute Care Surg. 2019; 86: 189-195
        • Smith A.S.
        • Trevelyan E.
        The Older Population in Rural America: 2012-2016.
        U.S. Census Bureau, 2018: 1-21
      1. WWAMI rural health research center RUCA map classifications.
        (Available at:)
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • Gold J.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • St-Louis E.
        • Iqbal S.
        • Feldman L.S.
        • et al.
        Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery.
        J Trauma Acute Care Surg. 2015; 78: 318-323
        • Bruenderman E.H.
        • Block S.B.
        • Kehdy F.J.
        • et al.
        An evaluation of emergency general surgery transfers and a call for standardization of practices.
        Surgery. 2021; 169: 567-572
        • Reinke C.E.
        • Thomason M.
        • Paton L.
        • Schiffern L.
        • Rozario N.
        • Matthews B.D.
        Emergency general surgery transfers in the United States: a 10-year analysis.
        J Surg Res. 2017; 219: 128-135
        • Sheetz K.H.
        • Waits S.A.
        • Krell R.W.
        • Campbell D.A.
        • Englesbe M.J.
        • Ghaferi A.A.
        Improving mortality following emergent surgery in older patients requires focus on complication rescue.
        Ann Surg. 2013; 258 (discussion 617-618): 614-617