Evidence map›Paper›PMID 40472456›Full record

ArticleSurgery2025

Evaluation of interfacility transfer patterns among patients with emergency general surgery conditions.

Nina M Clark, Rebecca G Maine, Mariam N Hantouli, Ellen Cooper, Alison Porter, Colleen M Sitlani, Nicholas L Smith, Giana H Davidson

Abstract read
In one paragraph

Article in Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nina M ClarkDepartment of Surgery, University of Washington, Seattle, WA. Electronic address: clarkni@uw.edu.
Rebecca G MaineDepartment of Surgery, University of Washington, Seattle, WA.
Mariam N HantouliDepartment of Surgery, University of Washington, Seattle, WA.
Ellen CooperDepartment of Surgery, Tahoe Forest Hospital, Truckee, CA.
Alison PorterDepartment of Surgery, Skagit Regional Health, Mount Vernon, WA.
Colleen M SitlaniCardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA.
Nicholas L SmithCardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA.
Giana H DavidsonDepartment of Surgery, University of Washington, Seattle, WA. Electronic address: https://twitter.com/gianamontana.

Funding

Renewal: Gastrointestinal Surgery Outcomes Research FellowshipT32DK070555 · NIDDK · UNIVERSITY OF WASHINGTON · PI FLUM, DAVID R · 2010 to 2024
$3.6M
NIDDK NIH HHS T32 DK070555
6 · The paper itself

Abstract

backgroundInterfacility transfer for emergency general surgery is a key strategy for improving access to care. However, lower-intensity transfers are linked to increased costs, poor patient and family experience, and inefficient resource allocation. Clinical and health system characteristics associated with lower-intensity transfers among patients with emergency general surgery conditions remain unclear.

methodsWe performed a cohort study among adults with emergency general surgery conditions using claims data from Florida and California. Lower-intensity transfers were defined as admissions ≤3 days with discharge to home without procedural intervention. These were compared with greater-intensity transfers (admission >3 days, nonhome discharge, or procedural intervention), lower-intensity nontransfers, and higher-intensity nontransfers. We used multinomial logistic regression to identify patient and facility factors present on admission that were associated with lower-intensity transfer compared with other encounter types.

resultsOf 211,466 patients who underwent emergency general surgery, lower-intensity transfers encompassed 0.7% of encounters overall and 30% of transfers. Factors associated with lower-intensity transfer compared with nontransfer included Medicaid insurance, history of bariatric surgery, patients presenting to a critical access hospital, patients with cholecystitis, and patients presenting with higher-complexity surgical disease. Patients presenting to hospitals with advanced gastroenterology and palliative care were less likely to undergo lower-intensity transfer (P < .05 for all).

conclusionFacility characteristics are associated with lower-intensity transfers among patients who undergo emergency general surgery and may be a future target for policy aimed at improving the efficiency and quality of regional emergency general surgery care. Understanding clinical and resource needs of patients who undergo emergency general surgery may facilitate the development of interventions to support emergency general surgery care in resource-limited settings and triage patients requiring high-complexity care to tertiary and quaternary facilities.

Indexed as

Patient TransferSurgical Procedures, OperativeAcute Care SurgeryAdultAgedCaliforniaCohort StudiesEmergenciesFemaleFloridaGeneral SurgeryHumansMaleMiddle AgedYoung Adult

Identifiers

PMID40472456
PMCPMC12380191

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.