Does Geographic Distance Constitute a Valid Prognostic Parameter for Outcomes in Emergency Patients Undergoing Interhospital Transfer?

Background: Rapid access to specialized cardiac surgical care is essential for optimal outcomes in patients with complex cardiovascular conditions. Interhospital transfer (IHT) programmes can bridge the gap between regional hospitals and tertiary centres. This study evaluates a coordinated IHT programme between a district hospital and a university medical centre, examining patient characteristics, transfer logistics, and clinical outcomes in elective, urgent, and emergency admissions.

Methods: We performed a retrospective cohort study of 793 patients transferred between January 2018 and March 2023. Patients were stratified by clinical urgency into elective (n = 240), urgent (n = 379), and emergency (n = 174) groups. Collected data included demographics, comorbidities, ASA classification, type of surgery, preoperative risk factors, transfer times, time from admission to surgery, and in-hospital mortality. Comparative analyses utilized the chi-square test, Kruskal–Wallis test, and Mann–Whitney U-test. Survival was analysed via Kaplan–Meier curves, and the influence of admission-to-surgery interval was further assessed using ROC analysis.

Results: Emergency patients exhibited significantly higher rates of preoperative myocardial infarction (55%), resuscitation (5.2%), shock states (16%), and ASA class IV (74%) compared with urgent and elective cases. Coronary artery bypass grafting (CABG) was the most frequent procedure overall (69%), rising to 80% in the emergency cohort. Median admission-to-operation times were 4 hours for emergencies, 25 hours for urgent cases, and 75 hours for electives (which were without IHT) (p < 0.001). In-hospital mortality peaked in the emergency group at 6.9% (p = 0.002). ROC analysis identified no predictive threshold for time to surgery. Geographic distance between referring and receiving centres did not independently affect survival or complication rates. Instead, preoperative patient stability, timing of surgery, and the quality of cross-sector communication—including a 24/7 hotline, telemetric data transmission, and regular videoconferences—were the principal determinants of outcome. Operative duration remained consistent across all urgency groups, reflecting standardized surgical protocols and process reliability.

Conclusion: A coordinated IHT programme with well-defined communication pathways, decision-making algorithms, and telemedicine support facilitates timely cardiac surgical care irrespective of geographic distance. Preoperative risk stratification and interdisciplinary coordination are critical for survival, particularly in emergency transfers. Further refinement of triage criteria and the comprehensive implementation of digital decision-support tools may enhance programme effectiveness and serve as a blueprint for regional care networks.

Keywords: Cardiac surgery; Interhospital transfer; Emergency surgery; Elective surgery; Urgent surgery; Patient outcomes.