Inter-Hospital Transfer and Outcomes in Acute Cholangitis: A National Inpatient Analysis

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  • Muhammad Haris Latif Department of Internal Medicine, SSM Health St. Mary’s Hospital, Saint Louis, Missouri, USA https://orcid.org/0000-0002-0649-3956 (unauthenticated)
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Imran Khokhar Department of Internal Medicine, Reading Hospital Tower Health, Reading, Pennsylvania, USA
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Ayesha Kang Department of Internal Medicine, SSM Health St. Mary’s Hospital, Saint Louis, Missouri, USA https://orcid.org/0009-0009-4258-1118
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Eman Mazhar Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Kahee A. Mohammed Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Joel Riley Department of Gastroenterology, SSM Health St. Mary’s Hospital, Saint Louis, Missouri, USA
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Hani El Halawany Department of Gastroenterology, SSM Health DePaul Hospital, Saint Louis, Missouri, USA
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.
  • Kamran Qureshi Department of Gastroenterology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
    Competing Interests
    The authors declare no conflicts of interest relevant to this study.

DOI:

https://doi.org/10.71079/ASIDE.GI.061026639

Abstract

Background: Inter-hospital transfer is frequently used to facilitate access to advanced biliary intervention and higher-level care for patients with acute cholangitis. However, its association with inpatient outcomes remains incompletely defined. We evaluated the relationship between transfer-in status and clinical outcomes among adults hospitalized with acute cholangitis.

Methods: We performed a retrospective hospitalization-level analysis using the National Inpatient Sample. Adult hospitalizations with acute cholangitis were identified using ICD-10-CM codes and stratified by interhospital transfer status. Survey-weighted analyses compared patient characteristics, outcomes, and resource utilization. Multivariable survey-weighted logistic regression assessed the adjusted association between transfer-in status and adverse outcomes.

Results: An estimated 36,125 acute cholangitis hospitalizations were identified nationally; 16.8% involved inter-hospital transfer. Transferred hospitalizations were more often among White patients, patients from lower-income ZIP codes, and those treated at large urban teaching hospitals. Transferred patients had higher unadjusted rates of shock, acute respiratory failure, mechanical ventilation, dialysis, and in-hospital mortality (5.8% vs 4.5%; P = 0.047). After adjustment, transfer-in status was not significantly associated with in-hospital mortality (adjusted odds ratio [aOR], 1.26; 95% CI, 0.95–1.68; P = 0.106), but was associated with acute respiratory failure (aOR, 1.30; 95% CI, 1.06–1.58; P = 0.011), mechanical ventilation (aOR, 1.64; 95% CI, 1.28–2.10; P < 0.001), and dialysis (aOR, 1.39; 95% CI, 1.01–1.92; P = 0.045).

Conclusions: Transfer-in status was not significantly associated with adjusted in-hospital mortality, but it was associated with markers of greater illness severity and resource utilization. Findings should be interpreted within the limitations of administrative hospitalization data.

Keywords:

Acute cholangitis, Inter-hospital transfer, National Inpatient Sample, Health services research, Biliary disease

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Data Availability Statement

The data that support the findings of this study are available from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. These data are not publicly shareable by the authors because they are subject to HCUP data-use restrictions and must be obtained directly from HCUP by eligible researchers. 

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Copyright (c) 2026 Muhammad Haris Latif, Imran Khokhar, Ayesha Kang, Eman Mazhar, Kahee A. Mohammed, Joel Riley, Hani El Halawany, Kamran Qureshi

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Vol. 2 No. 3 (2026): Issue 3

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Original Article

How to Cite

1.
Latif MH, Khokhar I, Kang A, et al. Inter-Hospital Transfer and Outcomes in Acute Cholangitis: A National Inpatient Analysis. ASIDE GI. 2026;2(3):24-31. doi:10.71079/ASIDE.GI.061026639

Article history

Received
4 Mar 2026
Received in revised form
7 May 2026
Accepted
11 May 2026
Published
10 Jun 2026