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Characteristics and Outcomes of Patients Transferred for Treatment of Acute Limb Ischemia

      Highlights

      • 1)
        Non-white patients are less likely to undergo transfer for acute limb ischemia (ALI).
      • 2)
        Patients with ALI were more likely to be transferred if they were functionally dependent or had COPD.
      • 3)
        Patients transferred for ALI are more likely to die within 30 days than those not transferred.

      Abstract

      Objective

      Patients requiring emergent vascular surgery often undergo transfer from one facility to another for definitive surgical care. In this study, we analyzed morbidity and mortality in patients presenting for emergent lower extremity thrombectomy and embolectomy in the transferred and non-transferred populations.

      Methods

      A retrospective analysis of prospectively collected data was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database for all non-elective, emergent lower extremity embolectomy or thrombectomy (Current Procedural Terminology [CPT] 34201 and 34203) performed between 2011-2014. Demographics, comorbidities, and 30-day complications and outcomes were compared among patients presenting from home versus those presenting from another hospital, emergency department, or nursing home. Multivariate analysis was performed to determine the association between mode of presentation, major complications, and death.

      Results

      We identified 1954 patients who underwent emergent lower extremity embolectomy or thrombectomy. 40.7% (795 patients) were identified as transfer patients. Odds of transfer were significantly increased if a patient was functionally dependent (OR 1.95, p <0.001) or had a history of chronic obstructive pulmonary disease (COPD) (OR 1.348, p = 0.05). Odds of transfer were decreased if a patient was of a non-white race (OR 0.511, p <0.001). 11.7% (229) patients in the described cohort died within 30 days of surgery. Those who died were more likely to present to the treating hospital as a transfer (56.3% versus 38.6%, p <0.001). In multivariate analysis, transfer status was significantly associated with 30-day mortality (OR 1.9: 95% CI 1.40-2.64; p <0.001).

      Conclusions

      Patients transferred from an outside hospital or nursing home who present for emergent vascular procedures demonstrated increased mortality compared to those who present from home direct to the emergency department despite similar comorbid conditions. In addition, race was identified as an independent factor for transfer. Further studies are needed to understand the complex interactions between inter-hospital transfer patterns, emergency vascular surgery presentations, and racial biases to improve outcomes for this population.

      Keywords

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