Transplant center treatment in emergency general surgery patients with a solid-organ transplant

Objective — We aimed to determine if treatment at non-transplant centers was associated with worse outcomes for patients with solid-organ transplants and an emergency general surgery condition.

Summary background data — Emergency general surgery diagnoses are common and hazardous in patients with solid-organ transplants. The ideal hospital for their treatment is controversial.

Methods — We performed a retrospective population-based cohort study using linked administrative data in Ontario, Canada. Adults with a solid-organ transplant and emergency general surgery condition hospitalized April 1, 2002-December 31, 2021 were included. Treatment at a transplant center was compared to other center types. The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, a composite of 30-day complications or mortality, and 30-day readmission. Adjusted analyses used multivariable logistic regression with generalized estimating equations accounting for repeat events.

Results — Amongst 2,679 hospitalizations in this population, 111 (4%) died at 30-days and 821 (31%) suffered complications or mortality. The adjusted association between 30-day mortality and center depended on transplant type and was higher at academic centers compared to transplant centers (aOR 3.52, 95%CI:1.43-8.65, p=0.006) for patients with kidney transplants. There was no association between center and mortality for non-kidney transplants. Regardless of transplant type, the composite of complications or mortality was significantly higher for most center types compared to transplant centers.

Conclusions — Non-transplant centers were associated with higher mortality for patients with kidney transplants, and our composite measure was increased in non-transplant centers for all organs. Emergency general surgery care for these groups should be preferentially offered at transplant centers.