EP155 - Appropriateness and patterns of colorectal surgery transfers to a tertiary referral center

Saturday, May 10, 2025

3:20 PM – 3:25 PM PT

Location: Monitor 8, Sails Pavilion, Upper Level

ePoster Presenter(s)

AB

Adam Berenson, MD

Fellow
Baylor Scott & White Health
Dallas, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SV

Siddarth Vyas, BS

Student
Baylor University Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
CF

Cyrus Feizpour, MD

Colorectal Surgery Fellow
Baylor University Medical Center
Dallas, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
IY

Irene S. Yu, MD

Fellow
Baylor Scott & White Health
Irving, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
WL

Warren Lichliter, MD

Surgeon
Baylor Scott & White Health
dallas, Texas, United States

Disclosure information not submitted.
EF

Edward Franko, MD

Attending
Baylor University Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
RR

Roberto Rodriguez-Ruesga, MD

Attending
Baylor University Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
Sarah Stringfield, MD (she/her/hers)

Attending
Baylor University Medical Center
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MP

Michael Pendola, MD

Attending
Baylor University Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
James W. Fleshman, Jr., MD

Surgeon
Baylor Scott & White Health
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Katerina O.K Wells, MD MPH (she/her/hers)

Colorectal Surgeon
Baylor University Medical Center, Dallas
Dallas, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Adam Berenson, MD: This individual has no financial relationships with ineligible companies.

Cyrus Feizpour, MD: This individual has no financial relationships with ineligible companies.

Irene S. Yu, MD: This individual has no financial relationships with ineligible companies.

Sarah Stringfield, MD: This individual has no financial relationships with ineligible companies.

James W. Fleshman, MD, Jr.: This individual has no financial relationships with ineligible companies.

Katerina O.K Wells, MD MPH: This individual has no relevant relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Transfer of patients to a tertiary referral center for surgical evaluation requires significant resources, and result in increased median length of stay and overall cost. The decision to transfer is multifactorial, with consideration for continuity of care, medical complexity, and subspecialty availability. We explored the appropriateness and patterns of transferred patients to our tertiary referral center for colorectal surgery evaluation.

Methods/Interventions: A retrospective review was performed of all patients requesting transfer to the colorectal surgery service at our hospital in Fiscal Years 2023 (July 2022 to June 2023) and 2024 (July 2023 to June 2024). These patients were divided into accepted and cancelled transfers. Patients were reviewed for demographic and transfer-specific data. Appropriate colorectal diagnoses for transfer were categorized into Crohn’s/UC, Malignancy/Large Bowel Obstruction, Intestinal Fistula, and Ostomy Complications/Rectal Prolapse. Patients were also considered appropriate if they had pre-existing care provided by the colorectal department or medical complexities (e.g. prior renal transplant) necessitating a higher level of care.

Results/Outcomes: A total of 447 transfers were initiated, 203 in FY23 and 244 in FY24. In FY23, 102 patients were accepted, however, 4 patients went to a different surgical service upon arrival. In FY24, 128 patients were accepted for transfer, and 6 of these were managed by another service (Table 1). These patients traveled a median distance of 33 miles (range 2-286) in FY23 and 34.5 miles (range 1-211) in FY24. Of the 217 cancelled transfers over two years, 43.8% (95 / 217) were due to lost bed availability, followed by 11.1% (24 / 217) due to the transfer no longer being needed, and 11.1% (24 / 217) for MD decline. There were a variety of less frequently cited reasons for the remaining cancellations.
The majority of patients, 65.3% (64 / 98) in FY23 and 50.8% (62 / 122) in FY24, were established with our group (Table 2). New patients arrived with a variety of diagnoses, however, malignancy/LBO was the most common in both years (12 patients in FY23 and 15 patients in FY24). We identified a total of 20 patients, 9.1% (20 / 220), that were deemed inappropriate transfers. During the transfer admission, many patients required an operation, endoscopy or IR procedure, and some patients required multiple. 54.1% (53 / 98) of patients in FY23 required at least one intervention, and 57.5% (70 / 122) in FY24.

Conclusion/Discussion: Our tertiary referral center serves as an important resource for the surrounding region, where complex colorectal patients can be managed with the expertise afforded by our department. The number of surgical or minimally invasive interventions these patients received during the transfer admission also indicates the need for a higher level of care. The transfer distance traveled by these patients raises some important questions. In our large metropolitan area, numerous hospitals have colorectal specialists, but often patients came further from their homes for care. The transfer process is a critical component for a tertiary referral hospital to provide specialized care not feasible in all community hospitals, but we also need to consider the resources required for both the healthcare system and the patients and their families.