Transfer of Obese Patients Who Undergo Emergency Colon Operation Is Associated with Worse Outcomes and Higher Mortality: An American College of Surgeons NSQIP Analysis

INTRODUCTION: The role of interfacility transfer for emergency colon operation is unclear. Generally, patients with comorbid conditions leading to worse outcomes are transferred more frequently. This study evaluates whether patients with obesity are transferred at an increased frequency and how this may affect outcomes. METHODS: The American College of Surgeons NSQIP database was queried for nonelective colon operation from 2016 to 2018. BMI was calculated from available data and patients were stratified according to BMI class and their location of origin. Subgroup analysis of patients with BMI >35 kg/m2 was performed. SPSS was used for statistical analysis. RESULTS: Of 43,607 patients undergoing urgent colon operation, 8,034 (18.4%) were transferred. Patients with BMI 35 to 40 kg/m2 or >40 kg/m2 were more likely to be transferred. When controlling for comorbid conditions with logistic regression, BMI >35 kg/m2 was an independent risk factor for transfer (odds ratio [OR] 1.362; p = <0.001). Subgroup analysis of BMI >35 kg/m2 (n = 6,248) revealed that transferred patients had higher rate of mortality compared with those not transferred (13.9% vs 7.8%, p < 0.001). These patients experienced lower rate of wound complication (11% vs 13.1%, p = 0.035) and readmission rate (12% vs 14.1%, p = 0.046), but higher rate of septic shock (22.7% vs 11.2%, p = 0.001) and return to operating room (13.6% vs 10.7%, p = 0.002). Controlling for other significant comorbid conditions, transfer status remained an independent risk factor for mortality (OR 1.362; p = 0.045). CONCLUSION: This demonstrates that patients with BMI >35 kg/m2 undergoing urgent colon operation are transferred more frequently than patients with lower BMI. In this population, transfer status is associated with higher mortality. Hospitals should consider whether interfacility transfer in this population is warranted.