The Association of External Transfer Status with Adverse Outcomes in Otolaryngology

Krish Suresh, Christopher J. Gouveia, Robert C. Kern, John D. Cramer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: To compare rates of morbidity and mortality in patients treated by otolaryngologists who undergo interhospital transfers vs those who do not and to quantify conditions requiring interhospital transfers in this population. Study Design: Cohort study. Setting: American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods: We identified patients requiring surgery by otolaryngologists in the National Surgical Quality Improvement Program database from 2006 to 2013. We compared patients who were transferred from an outside institution to those admitted from home. Multivariate regression was used to adjust for patient characteristics, comorbidities, and case mix. The primary outcome was overall morbidity and mortality within 30 days of surgery. Results: We identified 60,498 patients; 488 (0.8%) were transferred from another institution. Operations that were more common in the transferred group were incision and drainage (24.0% vs 1.2%), facial trauma repair (9.0% vs 3.1%), and oropharyngeal hemorrhage control (3.9% vs 0.4%). External transfer patients had significantly longer hospital stays (44.1% vs 4.4% >7 days, P <.05). On unadjusted analysis, transferred patients had a significantly higher rate of morbidity and mortality (odds ratio [OR], 11.3; 95% confidence interval [CI], 9.4-13.5). On multivariate analysis, transferred patients had a significantly greater rate of morbidity and mortality (OR, 3.1; 95% CI, 2.4-4.0). Conclusion: Transfer from another institution is associated with worse outcomes independent of case mix, demographics, and preoperative comorbidities in acute otolaryngology conditions requiring surgery. Practitioners should be aware of this when caring for transfer patients, and transfer status should be considered when measuring hospital quality.

Original languageEnglish (US)
Pages (from-to)848-853
Number of pages6
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume158
Issue number5
DOIs
StatePublished - May 1 2018

Keywords

  • National Surgical Quality Improvement Program
  • external transfer
  • head and neck surgery
  • otolaryngology
  • outcomes
  • quality

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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