Outcomes of Access Center Transfers for Thoracic Surgical Issues

Abstract

Background

Uninterrupted access to thoracic surgical care is limited to large tertiary care centers. Our aim was to characterize the value that interhospital transfers bring to a tertiary care center.

Methods

Retrospective review of access center calls for patients with thoracic surgery needs between April 2022 and August 2023 was performed. Data collected included number/time of calls, diagnosis of requested transfer, number of transfers, number/type of procedures performed, distance of transfer, and characteristics of in-system vs out-of-system patients. Procedures performed were defined as major (performed by thoracic surgeons) or minor (performed by nonthoracic surgery proceduralists).

Results

In total, 367 phone calls occurred over 17 months (22 calls/mo) with 261 calls (71%) leading to transfers. Of those transferred, 169 patients (65%) received an intervention, totaling 218 procedures. Of these procedures, 93 (43%) were major operations, accounting for 15% of thoracic surgery volume, and 125 (57%) were minor procedures. The most common major operations were decortication (33 of 94, 35%), and wedge resections (16 of 94, 17%). Fifty-one out-of-system hospitals accounted for a higher volume (58% vs 42%), and a longer median transfer distance (13.8 vs 48.1 miles). However, in-system transfers were more likely to lead to major thoracic procedures (49% vs 38%).

Conclusions

This is the first study to provide details on interhospital transfers for thoracic surgery needs. A substantial portion of transferred patients undergo an invasive procedure by thoracic surgeons and other proceduralists. The study highlights an underappreciated part of thoracic surgeons’ contribution to patient care in the community and hospital system.