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The Influence of Social Determinants of Health on The Interfacility Transport of Patients for Appendicitis

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      Introduction

      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.

      Methods

      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.

      Results

      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)

      Conclusion

      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.
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