Interhospital transfers of acute care surgery patients: should care of nontraumatic surgical emergencies be regionalised?

摘要

In this [1] and previous [2] articles Velmahos makes good arguments for regionalisation of acute surgical care. The study design and interpretation of data in this article, however, do little to advance the evidence base for regionalisation of care. This article proposes the hypothesis that patients with complex nontraumatic surgical emergencies transferred to a tertiary acute surgical service (ACS) from outlying community hospitals (OCHs) will have worse outcomes than similar patients admitted directly to the tertiary facility. An ideal study to explore this hypothesis would be to compare the outcomes of the whole cohort of patients who present to the OCHs with those of the whole cohort who present to the ACS. This design would require cooperation and sharing of data between the ACS and OCHs and was not pursued. Instead, the available database of the ACS was interrogated and the whole cohort of direct admissions to the ACS was compared to the cohort of the OCHs' most difficult patients who selected themselves for transfer to a tertiary centre due to ongoing clinical problems. Is it surprising that this second group had poorer outcomes?