Patients presenting to emergency departments with complaints requiring emergency general
surgery (EGS) often require transport to tertiary care because fewer than 50% of hospitals
have EGS services. The need for interfacility transport to tertiary care is associated
with increased hospital length of stay (LOS) and morbidity among medical patients.
Further Social Determinants of Health (SDOH) are known factors worsening patient outcomes.
There is limited data available evaluating the presence and influence of SDOH among
EGS patients transferred to tertiary care. The purpose of this study was to analyze
the costs, transport resource utilization, and outcomes of EGS patients transferred
to tertiary care with acute appendicitis.
This was an IRB approved retrospective study of adult patients transferred from an
in-network referral ED to a single tertiary care facility between 20 May 2015 & 30
September 2020 who were transferred with diagnosis of appendicitis. Data collected
from the health system's electronic medical record (EMR) included patient demographics,
emergency department and interfacility transport hemodynamics, diagnostic testing
results, timeliness of referral and transport, transport level of care, social determinants
of health, and patient charges. Data was analyzed with R version 1.0.2. Our Primary
Outcome was the hospital length of stay and our secondary outcomes were time from
initial presentation to incision, cost to patient, and transport resource allocation.
A total of 480 adult patients were transferred for tertiary EGS care during the study
period and were included in the final analysis. 89.4% of patients (n=429) received
ambulance transport awhile 10.6% (n=51) were transported via private vehicle. All
patients were discharged home alive. SDOH were documented as present in 25.5% of patients
transported via private vehicle and 30.8% of patients transferred via ambulance. The
presence of SDOH did not length emergency department length of stay (p=0.12) or hospital
length of stay (p=0.45). SDOH did not impact hospital length of stay when transport
mode was also considered (p=0.447)
In this single center study, the presence of SDOH did not influence ED or hospital
length of stay among patients transferred to tertiary care for appendectomy. Overall
SDOH were poorly reported in the hospital and ambulance electronic medical record.
Improved tracking of these social factors may alter the results of future research.