ArticleJournal of cardiothoracic surgery2025
Development of a coordinated interhospital transfer program for cardiac surgery patients.
Article in Journal of cardiothoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTimely access to specialized cardiac surgical care is essential for optimal outcomes in patients with complex cardiovascular conditions. Interhospital transfer (IHT) programs have the potential to bridge the gap between regional hospitals and tertiary centers. This study evaluates the establishment of a structured collaboration between a district hospital and a university medical center, with a coordinated interhospital transfer (IHT) program as a key component. Patient characteristics, transfer logistics, and clinical outcomes across elective, urgent, and emergent admissions were analyzed. Despite the presence of other tertiary centers in the region, the referring hospital consistently transferred patients to our center, which has become its sole cardiac surgical provider within this cooperation.
methodsA retrospective cohort study was conducted including 793 patients transferred between January 2018 and March 2023. Patients were classified based on clinical urgency as elective (n = 240), urgent (n = 379), or emergent (n = 174). Data collected included demographics, comorbidities, ASA classification, surgical type, preoperative risk factors, transfer times, time from admission to surgery, and in-hospital mortality. Comparative analyses used Chi-squared, Kruskal-Wallis, and Mann-Whitney U tests. Kaplan-Meier curves and ROC analysis were performed for survival and time-to-surgery impact.
resultsEmergent patients were significantly more often classified as ASA class 4 (74%) and had higher rates of preoperative myocardial infarction (55%), shock (16%), and CPR (5.2%) compared to urgent and elective patients. CABG was the predominant procedure (69%), especially among emergent cases (80%). Time from admission to surgery was significantly shorter for emergent patients (median 4 h) compared to urgent (25 h) and elective (75 h). In-hospital mortality was highest in emergent patients (6.9%, p = 0.002). ROC analysis did not reveal a predictive threshold for time-to-surgery.
conclusionA coordinated IHT program facilitates timely cardiac surgical care, particularly for high-risk emergent cases. Further refinement of triage criteria and integration of telemedicine may enhance program efficacy.
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