Value and Necessity of Vascular Surgery Transfers to a Tertiary Care Center

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

aortic disease, cohort analysis, conference abstract, consultation, female, human, limb ischemia, major clinical study, male, patient care, patient referral, patient triage, retrospective study, surgery, tertiary care center, vascular surgery, vascularization, workload

Abstract

Objectives: Hospital transfers for vascular surgery consultation can represent a source of considerable clinical strain on tertiary referral centers. The value of these transfers to receiving institutions remains poorly defined. This study aimed to characterize transfer patterns, operative needs, resource utilization, and economics for transfer patients at a single tertiary care hospital. Methods: A retrospective review of inter-hospital transfers involving vascular surgery consultation at a high-volume tertiary care center from January 1 to December 31, 2024 was performed. Transfers were stratified by referral source: system transfers were defined as a transfer from any hospital within our health system and external transfers were from any facilities outside of our health system. The primary outcome was the performance of a vascular operative intervention during the index admission. Secondary outcomes included transfer reason, timing (day shift 0800-1659 vs after hours 1700-0759), day of transfer (weekday defined as Monday to Thursday and weekend defined as Friday to Sunday), in-hospital mortality, and calculated financial margin associated with the transfer episode of care. Results: A total of 216 patients were transferred during this period, including 143 (66%) from system hospitals and 73 (34%) from external facilities. The majority were admitted to the vascular surgery service (81% system vs 85% external; P = .72) (Table). Vascular operative intervention was performed on 66% of system and 60% of external transfers (P = .37). System transfers occurred more commonly for limb ischemia (36%) and other thrombotic events, whereas external transfers were more frequently for aortic pathology (33%). External transfers were associated with longer lengths of stay (13 days vs 10 days; P = .009), greater transfer distance (90 miles vs 36 miles; P = .002), and trended toward a higher in-hospital mortality (15% vs 7%; P = .06). Most transfers occurred during off-hours (system 73% vs external 77%; P = .58) and approximately one-half were on weekends (system 43% vs external 55%; P = .09) (Table). There was no significant difference in mean profit margins between system and external transfers ($4241 vs $7198; P = .42), with a total estimated profit margin of $1.12 million for the year. Conclusions: Vascular surgery transfers frequently require an operative intervention, but nearly one-third do not. Although these transfers generate a net positive margin, they impose a considerable clinical workload during off-hours and weekends. These findings highlight the strain on a vascular surgery service at a busy tertiary care center and underscore the need for deliberate transfer triage processes that balance timely access to vascular expertise with responsible stewardship of limited resources. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e164

Last Page

e165

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